BACKGROUND AND OBJECTIVES: To assess the perception and management of central serous chorioretinopathy (CSCR) in Spain through a survey aimed at retinal specialists. MATERIAL AND METHODS: The working group designed an or...BACKGROUND AND OBJECTIVES: To assess the perception and management of central serous chorioretinopathy (CSCR) in Spain through a survey aimed at retinal specialists. MATERIAL AND METHODS: The working group designed an original online survey, including 42 questions categorized into 4 sections: clinical perception, diagnosis, clinical management, and prognosis. RESULTS: A total of 114 ophthalmologists completed the survey. The mean age was 46 years (range, 26-72), 54.5% were men, and the mean post-residency experience was 17.5 years. CSCR was perceived as a growing condition by 80% of participants. While 75% believed acute CSCR tends to resolve spontaneously, 63% estimated chronicity in <25% of cases; however, if chronicity occurs, 77% considered spontaneous resolution unlikely without treatment. Besides OCT, OCT angiography was the most used diagnostic imaging modalitu (72%), followed by fundus autofluorescence (65%). Systemic work-up was never considered by 30%, while 62% would only consider it in the presence of bilateral or multifocal cases, with cortisol being the most frequently investigated parameter. Observation is preferred in acute CSCR, while photodynamic therapy is favored in chronic forms. Focal laser and anti-VEGF agents are preferred for extrafoveal leaks and neovascular membranes, respectively. While 80% expect anatomical improvement with treatment, there is consensus on its limited functional benefits. CONCLUSIONS: This survey highlights that CSCR is perceived as an increasingly prevalent disease with high recurrence and potential for chronicity. It also reveals preferences and variability in its management among specialists.
OBJECTIVE: To evaluate the safety and efficacy profile of the fluocinolone acetonide implant (FAI) in patients with non-infectious posterior segment uveitis over a 60-month follow-up period. METHODS: We retrospective con...OBJECTIVE: To evaluate the safety and efficacy profile of the fluocinolone acetonide implant (FAI) in patients with non-infectious posterior segment uveitis over a 60-month follow-up period. METHODS: We retrospective conducted a study with a mean follow-up of 47 months (minimum, 18; maximum, 60). The study included 11 eyes (9 patients), with a male-to-female ratio of 8:1. The etiology of uveitis was heterogeneous. Efficacy parameters included visual acuity (VA) and Central macular thickness (CMT), and the ones who needed adjuvant therapy or re-injection. Safety parameters focused on the development of cataracts and intraocular hypertension. RESULTS: Real-world outcomes were assessed. Both VA recovery and CMT reduction were achieved between 3 to 6 months after FAI implantation and remained stable at the follow-up. All patients but one were pseudophakic prior to implantation. The phakic patient developed early cataract formation, requiring surgery 9 months post-implantation. All cases had previously received intravitreal dexamethasone. Five eyes (45.4%) required topical hypotensive therapy, and none glaucoma surgery. No patient required periodic adjuvant therapy or additional FAI injections, even among those with the longest follow-up periods. Two cases (18.1%) exhibited mild inflammatory activity in the macular area at months 33 and 35 post-implantation. These episodes were successfully resolved with sub-Tenon triamcinolone injections, maintaining clinical stability thereafter. CONCLUSIONS: The fluocinolone acetonide implant (FAI), in our series of cases, turned out to be an effective and safe therapy for non-infectious uveitic macular edema, providing sustained and long-lasting effects, in some cases up to 60 months post-implantation. Sub-Tenon triamcinolone proves to be a valuable adjunctive therapy.
INTRODUCTIONS AND OBJECTIVES: This study assesses risk factors for developing cataracts after vitrectomy with tamponade for rhegmatogenous retinal detachment (RRD) in phakic patients and explores the potencial causal rel...INTRODUCTIONS AND OBJECTIVES: This study assesses risk factors for developing cataracts after vitrectomy with tamponade for rhegmatogenous retinal detachment (RRD) in phakic patients and explores the potencial causal relationship between RRD surgery and the development of cataracts. MATERIALS AND METHODS: This was a retrospective study analysing the medical records of patients undergoing RRD surgery between 2012 and 2020 (9 years) at Donostia University Hospital (HUD). We collected data on the date of phacoemulsification surgery after vitrectomy surgery for RRD, as well as the type of vitrectomy and patient characteristics. RESULTS: Patients who underwent cataract surgery were on average older (mean age of 60.79 years old ± 9.49) than those who did not undergo this type of surgery during follow-up (52.97 years old ± 13.59), the difference being statistically significant (0P < .0001). Classifying patients by age at the date of the vitrectomy (≤50 years or >50 years of age), we found between-group differences in phacoemulsification rates after vitrectomy in the follow-up period, cataract surgery being performed in a third of the younger group and three-quarters of the older group (P < .0001). CONCLUSIONS: Patients with phakic RRD under 50 years old have a lower risk of cataract development after vitrectomy with tamponade than those over 50 years old. The use of long-acting tamponade gases such as C3F8 and silicone oil in phakic patients seems to increase the likelihood of needing early cataract surgery after RRD surgery with PPV.
OBJECTIVE: To evaluate the measurement accuracy of 2 swept-source optical biometers, the IOLMaster 700 and the Revo FC 130, in patients diagnosed with cataracts. METHODS: We conducted a prospective, observational and com...OBJECTIVE: To evaluate the measurement accuracy of 2 swept-source optical biometers, the IOLMaster 700 and the Revo FC 130, in patients diagnosed with cataracts. METHODS: We conducted a prospective, observational and comparative study in patients older than 40 years with cataracts. A single operator performed optical biometry using both devices during the same session. Cataract grading was conducted using the Lens Opacities Classification System III. RESULTS: Biometric measurements were obtained from the 504 eyes of 279 patients, with a mean age of 70.93 ± 8.41 years. Statistically significant differences were found between the IOLMaster 700 and Revo FC 130 in the following parameters: mean keratometry (43.53 ± 1.56 vs 44.27 ± 1.68 diopters), total average keratometry and mean keratometry (43.56 ± 1.55 D vs 44.27 ± 1.67 diopters), white-to-white distance (11.98 ± 0.52 vs 12.66 ± 0.73 mm), and lens thickness (4.53 ± 0.40 vs 4.60 ± 0.40 mm). No significant differences were found in axial length (23.31 ± 0.96 vs 23.25 ± 1.01 mm) or anterior chamber depth (3.02 ± 0.38 vs 3.02 ± 0.37 mm), which were not clinically relevant. No statistically significant differences were found between the IOLMaster 700 measurements of total mean keratometry (43.53 ± 1.56 diopters) and mean keratometry (43.56 ± 1.56 diopters). CONCLUSIONS: Although most measurements do not reveal any clinically relevant differences, the 2 devices should not be used interchangeably, mainly due to variations in keratometry readings.
OBJECTIVE: To determine the state of ocular surface and tear film in college students who are users of inhalants, mainly vapers. METHODS: We conducted a descriptive, observational, and cross-sectional study with 62 parti...OBJECTIVE: To determine the state of ocular surface and tear film in college students who are users of inhalants, mainly vapers. METHODS: We conducted a descriptive, observational, and cross-sectional study with 62 participants whose sociodemographic characteristics, ocular surface status, tear film and variables related to vaping were evaluated. Individuals with a higher (5-7 times per week of consumption) and lower frequency of vaping (1-4 times per week of consumption) were evaluated. Symptom documentation was standardized using the OSDI questionnaire and biomicroscopy to evaluate ocular adnexa and anterior segment structures, blinking frequency and eye protection index (EPI) were also determined. RESULTS: A total of 76% of participants were men with a median age of 20.37 years, and an age range between 18 and 28 years. Participants with a higher frequency of vaping exhibited blepharitis (60%) (P-value > .05), meibomian gland obstruction (65.63%) (P-value > .05), tarsal conjunctival hyperemia (52.94%) (P-value < .05), tarsal conjunctival hyperemia (52.94%) (P-value < .05), generalized bulbar hyperemia (72.73%) (P-value > .05), papillary reaction (60%) (P-value > .05), conjunctival staining (75%) (P-value > .05), limbal redness (61.54%) (P-value > .05). A normal Schirmer I (median 31 mm/5 min), short tear breakup time (median 3.5 s in BUT) and a lower number of blinks per minute (median 10.75) were found, yet the EPI was lower (median 0.58). CONCLUSIONS: Vaping could be associated with ocular health alterations, such as blepharitis, meibomian gland obstruction, conjunctival hyperemia, conjunctival staining and altered tear quality. Follow-up studies are recommended to establish causal relationships.
INTRODUCTION AND OBJECTIVES: To assess prevalence of classic clinical signs of Pigment Dispersion Syndrome (PDS) in PDS and Pigmentary Glaucoma (PG) in caucasian patients from Southern Spain. MATERIALS AND METHODS: Cross...INTRODUCTION AND OBJECTIVES: To assess prevalence of classic clinical signs of Pigment Dispersion Syndrome (PDS) in PDS and Pigmentary Glaucoma (PG) in caucasian patients from Southern Spain. MATERIALS AND METHODS: Cross-sectional observational case-series study evaluating the prevalence of characteristic clinical signs of PDS: Krukenberg spindle (KS), Trabecular meshwork pigmentation (TMP) and Iris transillumination defects (ITD). Differences between PDS and PG patients are evaluated and the probability of association with PG of clinical signs with statistically significant differences is also calculated (Odds Ratio OR in logistic regression analysis). RESULTS: 144 PDS/PG patients. Prevalence of KS, TMP and ITD is 91%, 88.9% and 24.3%. 48 right eyes (66.7%) were PDS and 24 right eyes (33.3%) were considered PG patients. Prevalence of KS is 95.8% in PDS and 91.7% in PG (p = 0.47). Prevalence of TMP is 87.5% in PDS and 95.8% in PG (p = 0.26). Prevalence of ITD is 16.7% in PDS and 41.7% in PG (p = 0.02). OR of those presenting PG is 3.57 for ITD (95% CI 1.17 to 10.85) (p = 0.02). CONCLUSIONS: There are no major differences in the prevalence of KS and TMP in our population of patients with PDS/PG compared to published data in the Caucasian population (91% vs 95% for KS and 88.9% vs 86% for TMP) but there are differences in the prevalence of ITD (24.3% vs 86%).
BACKGROUND AND OBJECTIVE: Bacteria isolated in postoperative endophthalmitis (PE) were reduced to cefuroxime-resistant bacteria in cataract surgery with intracameral cefuroxime as prophylaxis; age > 84 years was at risk...BACKGROUND AND OBJECTIVE: Bacteria isolated in postoperative endophthalmitis (PE) were reduced to cefuroxime-resistant bacteria in cataract surgery with intracameral cefuroxime as prophylaxis; age > 84 years was at risk for PEs caused by Gram-negative-bacteria and Staphylococci; no risks were identified for Enterococci, the most abundant isolations. The prevalence of Enterococci in the preoperative conjunctiva was associated with age > 74 years, diabetes, obesity, and dacryocystorhinostomy-history (DCR-history). The aim of the study is to differentiate the risk of age from that of other patient characteristics, establishing 2 different age groups. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study in a tertiary referral center. In 7,085 patients < 75 years old and 7,798 ≥ 75 years, the incidence rate ratio (IRR) of Enterococci, Enterobacteriaceae, Non-fermentative-Gram-negative-bacilli (NFGNB) and Coagulase-negative-Staphylococci (CNS) was calculated for the following factors: diabetes, obesity, DCR-history, sex-male, smoking-habit, and climate, using multivariate Poisson regression, IBM SPSS Statistic for Windows, version 25.0. Armonk, NY: IBM Corp. RESULTS: Diabetes, obesity, male-sex and smoking-habit were more prevalent in patients < 75 years old. The IRRs of Enterococci, Enterobacteriaceae and NFGNB were higher in this age group: [Enterococci IRRs: diabetes, 1.54 vs 1.42; obesity, 2.95 vs 1.50; DCR-history, 3.78 vs 1.08]; [Enterobacteriaceae IRRs: diabetes, 1.47 vs 1.13; obesity, 2.27 vs 1.99; male-sex, 1.76 vs 1.65]; [NFGNB IRRs: diabetes, 1.79 vs 1.16; autumn-weather, 2.05 vs 1.56]. Diabetes-obesity simultaneously: Enterobacteriaceae IRR, 3.30 vs 2.28; Enterococci IRR, 3.28 vs 1.62. CONCLUSIONS: Diabetes, obesity and DCR-history increase the IRR of Enterococci, Enterobacteriaceae and NFGNB in patients < 75 years more than they actually do in patients ≥ 75.
We report the case of a 74-year-old woman with high hyperopia and nanophthalmos who presented with a progressive central scotoma in her left eye. Best-corrected visual acuity was limited to hand motion, and examination r...We report the case of a 74-year-old woman with high hyperopia and nanophthalmos who presented with a progressive central scotoma in her left eye. Best-corrected visual acuity was limited to hand motion, and examination revealed a full-thickness macular hole associated with retinal detachment. Pars plana vitrectomy with the inverted internal limiting membrane (ILM) flap technique and 20% sulfur hexafluoride (SF6) tamponade was performed, but hole closure was not achieved. A second surgery including phacovitrectomy, retinal massage and ILM flap repositioning resulted in successful anatomical closure and visual improvement. This case highlights the value of adjunctive techniques such as retinal massage and accurate ILM flap repositioning to promote closure in complex and uncommon scenarios.
Vogt-Koyanagi-Harada (VKH) syndrome is a rare inflammatory disease that affects more than one system, including ophthalmological, auditory, cutaneous, and neurological systems. VKH syndrome is mostly characterized by pan...Vogt-Koyanagi-Harada (VKH) syndrome is a rare inflammatory disease that affects more than one system, including ophthalmological, auditory, cutaneous, and neurological systems. VKH syndrome is mostly characterized by panuveitis with serous retinal detachment, headache, hearing loss, vitiligo, and poliosis. Early diagnosis and proper management are crucial to prevent irreversible visual loss and other complications. We present a case report of VKH syndrome in a 29-year-old female patient. Initiation of corticosteroid therapy led to gradual regression of her symptoms. However, after cessation of corticosteroid therapy, the patient's visual acuity decreased, and the symptoms reappeared. Consequently, combination therapy with corticosteroid, azathioprine, and cyclosporine controlled the disease and stabilized clinical findings.This article highlights that early diagnosis and treatment of VKH syndrome with corticosteroid along with azathioprine and cyclosporine in the acute phase may improve a patient's quality of life and reduce the severity of the disease.
This is the case of a 14-years-old woman referred to our ophthalmology department with suspected iris juvenile xanthogranuloma, with reported bilateral, hematic recurrent uveitis as soon as she discontinued treatment wit...This is the case of a 14-years-old woman referred to our ophthalmology department with suspected iris juvenile xanthogranuloma, with reported bilateral, hematic recurrent uveitis as soon as she discontinued treatment with topical prednisolone acetate eye drops. After numerous treatments at the 3-year follow-up, including oral steroids, repeated injections of subtenon triamcinolone acetonide and intracameral and intravitreal anti-VEGF, treatment with intravitreal fluocinolone acetonide implant (ILUVIEN®) in both eyes was decided. Evolution since then and at the 10-month follow-up has been satisfactory; the patient has not exhibited any new episodes of ocular inflammation or hyphema despite the progressive withdrawal of topical corticosteroids, and vision has remained at 20/20 in both eyes. As far as we know, this is the first case of bilateral ocular juvenile xanthogranuloma successfully treated with an intravitreal fluocinolone implant.
Garcia-Martin E, Vicente Altabas MJ, Vilades Palomar E
… +5 more, Orduna Hospital E, Cordon Ciordia B, Garcia-Campayo J, Puebla-Guedea M, Satue Palacian M
BACKGROUND: Pathophysiology of fibromyalgia is still not well known. There are certain theories than point out a possible neurodegeneration component. OBJECTIVES: To evaluate variations in visual function parameters and...BACKGROUND: Pathophysiology of fibromyalgia is still not well known. There are certain theories than point out a possible neurodegeneration component. OBJECTIVES: To evaluate variations in visual function parameters and in the macular ganglion cell layer (CGR) of patients with fibromyalgia (FM) over a period of 5 years, and compare these results with controls. METHODS: 85 patients with FM and 41 healthy subjects underwent a complete ophthalmic evaluation, including assessment of visual acuity (VA) with ETDRS, contrast sensitivity vision (CSV) with Pelli Robson, color vision with Farnsworth and Lanthony D15 tests and retinal evaluation using Cirrus HD-OCT 3000 (Carl Zeiss, California). All subjects were re-evaluated after 5 years. It was also analyzed the association between progressive structural, functional and disease severity changes. Furthermore, patients were classified into three groups (1, atypical; 2, depressive; 3, biologic). RESULTS: Progressive changes were detected in visual function parameters and CGR thickness in FM patients after 5 years. Patients with FM presented worse low contrast VA (p = 0.022), color discrimination (Lanthony's C index, p = 0.006) and decreased CGR thickness (nasal inferior, p < 0.001) over the follow up time, compared with controls. Changes in color vision were associated with CGR thinning, but no correlations with disease severity were observed. CONCLUSIONS: It has been noticed progressive visual dysfunction and CGR loss in patients suffering from FM. The analysis of visual function parameters and CGR thickness using Cirrus OCT could be of value to control FM disease.
PURPOSE: Primary congenital glaucoma (PCG) is a significant cause of childhood vision loss. While visual acuity can be measured, it does not always reflect visual functioning in daily life, particularly as oculomotor ski...PURPOSE: Primary congenital glaucoma (PCG) is a significant cause of childhood vision loss. While visual acuity can be measured, it does not always reflect visual functioning in daily life, particularly as oculomotor skills are often compromised in ocular disorders. This pilot study assesses oculomotor behavior in children with PCG compared to healthy peers using the Device for an Integral Visual Examination (DIVE). METHODS: Twelve children with PCG (n = 24 eyes) and 24 healthy children (n = 48 eyes), aged 6 months to 4 years, were recruited. DIVE was used for automated oculomotor assessments, measuring fixation (gaze stability, fixation stability, and duration of fixation), saccadic movements (reaction time, peak velocity), and smooth pursuit (latency, gain). RESULTS: PCG children showed significantly poorer gaze stability in both short (0.68 log degree, 0.29-0.94 frente a 0.15 log degree, -0.17-0.59; p < 0.05) and long tasks (1.08 log degree, 0.79-1.84 frente a 0.57 log degree, 0.30-0.85; p < 0.05), and poorer fixation stability in short (-0.20 log degree, -0.27 to -0.17 frente a -0.48 log degree, -0.55 to -0.30; p < 0.05) and long tasks (-0.11 log degree, -0.20 to -0.04 frente a -0.41 log degree, -0.57 to -0.26; p < 0.05). Fixation durations were shorter, and saccadic reaction times were longer in the PCG group, while pursuit latency showed no significant difference (p = 0.8118). CONCLUSIONS: Children with PCG have significantly impaired oculomotor behavior, including greater instability in gaze and fixation, shorter fixation durations, and longer saccadic reaction times compared to healthy peers.
INTRODUCTION AND OBJECTIVES: XYY syndrome is relatively common and misdiagnosed. In addition high myopia appears to be more frequent in this syndrome than in the general population. Therefore, the objective of the presen...INTRODUCTION AND OBJECTIVES: XYY syndrome is relatively common and misdiagnosed. In addition high myopia appears to be more frequent in this syndrome than in the general population. Therefore, the objective of the present report is to emphasize the association of XYY syndrome and high myopia. MATERIALS AND METHODS: Case report of a single patient. RESULTS: An 8-year-old male patient with a history of XYY syndrome was examined. Physical examination revealed tall stature, low-set auricular pavilion implantation, mid-face hypoplasia, horizontal palpebral fissures. Ophthalmological evaluation showed early-onset high myopia in both eyes and a complete nuclear cataract and chronic retinal detachment in the right eye. DISCUSSION: Patients with XYY syndrome appear to exhibit a high prevalence of myopia. Although the pathophysiology of myopia in patients with XYY syndrome is not yet fully understood, it should be considered as a differential diagnosis for syndromic myopia.
Osteoma is a benign, slow-growing bone tumor that primarily affects the jaw and paranasal sinuses. Intraorbital location, whether primary or secondary, is rare. Although it is generally asymptomatic, it can become sympto...Osteoma is a benign, slow-growing bone tumor that primarily affects the jaw and paranasal sinuses. Intraorbital location, whether primary or secondary, is rare. Although it is generally asymptomatic, it can become symptomatic. As it grows, orbital osteoma can cause symptoms due to displacement and compression of the orbital contents posing a risk to vision. This article is a literature review and case report of a large primary orbital osteoma in a 36-year-old woman, initially asymptomatic and later exhibiting a few symptoms despite significant displacement of the orbital structures that the tumor causes. Its handling was controversial for us because we did not have references on the approach we should be taking. To this date, no cases of asymptomatic intraorbital osteomas of this size have ever been published.
Perforation of the eyeball during retrobulbar anesthesia is rarely reported. A case of inadvertent ocular perforation during retrobulbar anesthesia in cataract surgery is presented. Retinal complications and follow up af...Perforation of the eyeball during retrobulbar anesthesia is rarely reported. A case of inadvertent ocular perforation during retrobulbar anesthesia in cataract surgery is presented. Retinal complications and follow up after six months are described. A 58-year-old man presented with vision loss following cataract surgery on his right eye by phacoemulsification and intraocular lens implantation under retrobulbar anaesthesia performed one week earlier. Visual acuity was 0.05. Fundus examination revealed a vitreous haemorrhage in the lower area. A rounded haemorrhage was present next to the lower temporal arcade with a possible entry orifice. Optical coherence tomography, tomographic angiography and fluorescein angiography showed retinal ischaemia in the juxtapapillary macular area. The patient was followed for 6 months. Visual acuity improved to 0.5. Optical coherence tomography and tomographic angiography showed a reduction of the edema in the retinal layers, with a persistent loss of the inner nuclear and outer plexiform layer. Accidental intravitreal injection of bupivacaine and lidocaine during retrobulbar anaesthesia can result in permanent visual impairment. Extreme attention should be paid to the injection technique to avoid this complication.