Purpose: To describe the characteristics of the donor and recipient, indications, surgical techniques, and survival results obtained from patients with corneal transplants performed at Fundación Oftalmológica Nacional (FUNDONAL) between 2010 and 2017. Methods: Descriptive, observational study. Medical records of patients who underwent corneal transplantation were reviewed. Demographic data, surgery indication, transplantation technique, graft transparency, and presence of rejection are evaluated. Statistical analysis was performed with the SPSS software version 21.0. Results: Seven hundred and twelve eyes from 690 patients who underwent corneal transplantation were analyzed. The median age of the recipient was 42 years (interquartile range 21.8 years) and 392 participants (56.8%) were men. Corneal ectasias was the first indication for transplantation. The technique performed most often was penetrating keratoplasty (PK) (89.6%), followed by deep anterior lamellar keratoplasty (5.3%), endothelial keratoplasty (3.5%), and sclerokeratoplasty (1.5%). 22.25% of the cases presented at least one rejection episode. Transparency of the graft is >80% up to 36 months from follow-up. Conclusions: In 712 eyes that underwent corneal transplantation between 2010 and 2017, the most frequent indications were corneal ectasias, pseudophakic/aphakic bullous keratopathy, and previous graft failure. Although the most common technique is PK, there is a tendency to perform more lamellar transplants over the years. Survival up to the last control was 78% with graft rejection at 22.23%, which are comparable with results reported in the scientific literature. This study constitutes the first corneal transplant registry in Colombia, with survival results and description of variables that will allow for the identification of risk factors for undesirable outcomes.

Background: Pterygium is an ocular surface lesion that causes chronic eye irritation and eventually, vision impairment. Pathologically, prolonged ultraviolet (UV)-induced radiation damage leads to conjunctival and limbal stem cell damage. As such, rural, high-altitude equatorial communities are at particular risk due to proximity to the sun, outdoor work, and a lack of access to eye care. Methods: We conducted a cross-sectional study to determine the epidemiology of pterygium in the Chimborazo region of Ecuador. Adults presenting to Clinical FIBUSPAM's medical clinics for both ocular and nonocular reasons were examined by optometrists/ophthalmologists to identify pterygium. Affected patients completed a questionnaire about self-reported known risk factors, treatment, and barriers to care, and received UV-blocking sunglasses. Results: Of 296 patients, 165 (55%) had pterygium. The mean age was 60.2 years (range 19–88), 69% were female; 63% had unilateral pterygia, and 37% had bilateral pterygia. Symptoms occurring daily included severe photophobia (36%), foreign body sensation (28%), eye pain (24%), burning (31%), and itching (28%). In addition, 40% reported concern about eye appearance. Risk factors included spending >5 h outdoors each day working (93%), smoking (8%), and alcohol (14%). For prophylaxis, while 91% routinely wore hats outdoors, only 16% used sunglasses. For treatment, 30% used eye drops, of which two-thirds were natural remedies. About 93% wanted treatment (medications or surgical removal), 78% were concerned about access to treatment, and 43% reported cost as the major concern. Conclusions: Pterygium is highly prevalent (55%) among adults presenting for care in community health clinics in the Chimborazo Province of Ecuador. This treatable and potentially preventable cause of ocular irritation and vision loss greatly impacts the quality of life in this region. This and similar communities would benefit from improved education and outreach through care delivery models that bring affordable prevention and eye care services closer to home.

Optic perineuritis (OPN) is a rare inflammatory disease involving the optic nerve sheath. Most cases are idiopathic, but associations with a variety of infectious and inflammatory conditions have been described. Patients with suspected OPN should also be investigated for neoplasms in the form of optic nerve sheath meningioma or meningeal carcinomatosis, given they share important clinical and radiological features. We present a case of suspected idiopathic bilateral OPN that was particularly challenging, eventually revealing a neoplastic etiology.

Given the increasing incidence of obesity, bariatric procedures are gaining attention during the past decades, being one of the most effective methods of long-term weight loss. Nutritional optic neuropathy (NON) following bariatric surgeries is a rare but devastating complication caused by a complete lack or inadequate supply of nutrients for the normal function of nerve fibers. We report a case of bilateral anterior NON after a Single Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy, and present a review of the literature about neuro-ophthalmic complications associated with these procedures. Bariatric surgery may constitute an established risk factor for NON and both patient and physician have to be aware of the importance of closely monitoring vitamin depletions and neurologic and visual symptoms.

A 63-year-old woman with high hyperopia developed acute myopia of − 5.50 D with axial shallowing of anterior chamber and high intraocular pressure (IOP) in her left eye after 2 weeks of phacoemulsification surgery. She developed a myopic shift after 4 weeks in the right eye also which was operated 8 months ago for cataract. Laser peripheral iridotomy was ineffective in both eyes. Cycloplegic therapy was started for presumed aqueous misdirection syndrome (AMS) with antiglaucoma drugs in both eyes. A laser capsulo-hyaloidotomy was attempted in LE with no result. Pars plana vitrectomy (PPV) with iridectomy-zonulectomy-hyloidectomy (IZH) was done in both eyes after 2 years of onset and multiple recurrences associated with atropine withdrawal. Pseudophakic AMS can present as a myopic shift in refraction without a significant rise in IOP. Cycloplegic therapy is not well tolerated by multifocal intraocular lens patients. PPV with IZH has been effective in preventing relapses in our patient for 20 months (RE) and 23 months (LE).

We report a case of bilateral retinal hemorrhages with macular edema in a patient with dengue fever (DF). This patient also had cerebral hemorrhage. A 17-year-old female presented with sudden painless loss of vision in her both eyes for 2 days associated with redness of eyes. She was diagnosed having DF based on detected dengue immunoglobulin M in her blood sample. Fundus examination of both eyes showed preretinal and intraretinal hemorrhages. Optical coherence tomography showed neurosensory detachment and macular edema. This case report warrants the importance of ocular screening in a patient having systemic complications of DF.

The severe acute respiratory syndrome caused by coronavirus-2 can present with a broad spectrum of clinical manifestations, mainly respiratory, but also with different neurologic symptoms. On the other hand, the Ramsay Hunt syndrome (RHS) is a complication of varicella-zoster virus (VZV) reactivation presenting mainly in older patients, patients under stress, infection, or an immunocompromised state. We report a case of RHS in a young Mexican female patient who tested positive for SARS-CoV-2 in whom we believe that there is a strong possibility that VZV's unusual reactivation, presenting as RHS in a young patient, might have been a consequence of the immunological alterations induced by this coronavirus.

Orbital mucormycosis is a dreaded condition and may lead to fatal intracranial infection if it spreads to the intracranial sinuses. The infection is caused by fungi of the order Mucorales. Rhizopus has been reported to be the causative pathogen. The main route of infection is through inhalation of the fungal spores, which may cause lung infection. However, patients with diabetes, immunosuppression, and steroid use are more prone to the infection. We present a case of orbital mucormycosis in a patient who had recovered from coronavirus disease 2019. Early diagnosis and management helped salvage the vision of the patient.

Anisometropia is characterized by difference between the refractive errors of the eyes and can be classified into refractive and axial. Aniseikonia is one of the possible consequences of anisometropias. As a general rule, aniseikonia tends to be less significant when we correct axial anisometropias with spectacles and refractive anisometropias with contact lens. One of the possible causes of refractive anisometropias is aphakia, which can be a result of ocular trauma. Amblyopia is a visual neurological disorder characterized by inadequate consolidation of visual acuity, due to insufficient visual stimulation. We present a case of contact lens fitting in a patient with significant difference in axial length between the eyes, but without the corresponding anisometropia, since the patient became aphakic after blunt trauma during childhood affecting the eye with the longest axial length, and probably as a consequence of the aphakia, she did not become amblyopic.

We report the clinical findings and imaging in an 11-month-old male referred to the pediatric ocular oncology service for leukocoria. The diagnosis of concomitant myelinated nerve fibers and retinoblastoma group O/C was established. In this case, the association of these two conditions led to early diagnosis of retinoblastoma with successful treatment and good visual outcome.

Purpose: The purpose of this study was to determine the expression of anaplastic lymphoma kinase (ALK) in uveal melanoma (UM) to evaluate its potential utility as a therapeutic target. Materials and Methods: A total of 80 formalin-fixed paraffin-embedded enucleated eyes of UM patients, as well as 11 eyes and 11 pulmonary metastases from a rabbit model of human UM, were collected. All samples were stained for ALK using a fully automated immunohistochemical procedure. Human UM cases were classified according to cell type in spindle or epithelioid. Differences in ALK positivity according to cell type were determined using Pearson's Chi-square test. Results: In human UM specimens, ALK was positive in 2 of 39 spindle cell type cases (2.5%) and in 13 of 41 (16.25%) epithelioid cell type cases. The difference in ALK expression between cell types was statistically significant (P = 0.002). In the animal model of human UM cells, all cases (100%) were positive for ALK in both ocular and pulmonary lesions. Conclusion: ALK is expressed in a small proportion of UM, with statistically significant more expression in the more aggressive epithelioid cell type. Furthermore, when ocular tumors and corresponding lung metastasis from a highly metastatic animal model of UM were examined, ALK was positive in all samples. Collectively, our data suggest that ALK expression may be associated with more aggressive tumors. To the best of our knowledge, this is the first demonstration of the potential of ALK as a therapeutic target in human UM, particularly in aggressive tumors.

Congenital fibrosis of extraocular muscles (CFEOM) is an inherited restrictive ocular motility disorder characterized by unilateral or bilateral horizontal and/or vertical gaze impairment with ptosis. Keratoconus is a bilateral asymmetrical corneal ecstatic disease with multifactorial etiology, including complex interaction of both genetic and environmental factors. We report a case of a 29-year-old female who presented with chief complaints of bilateral diminution of vision and drooping of eyelids since early childhood with a history of seizures for 1 year. Visual acuity at presentation was hand movement close to face with accurate projection of rays in both the eyes. Contrast-enhanced magnetic resonance imaging of the brain and orbit revealed partially empty sella, neurocysticercosis, and bilateral atrophy of extraocular muscles. On detailed examination, she was found to have CFEOM type 1A (CFEOM1A, autosomal dominant inheritance) with bilateral advanced keratoconus, bilateral sensorineural hearing loss, bilateral presenile cataract, and neurocysticercosis. The association of CFEOM1A, keratoconus, and sensorineural hearing loss is not reported in the literature to date. Whether this association is co-incidental or part of some new syndrome needs to be evaluated further.

Purpose: The purpose of this study is to investigate the epidemiological profile and prescription of optical, nonoptical, and electronic devices in the elderly aged 80 years or older, in a low-vision rehabilitation center in Belo Horizonte, Brazil. Methods: This is a retrospective, observational, descriptive study held in a low-vision rehabilitation center in Belo Horizonte, from 1992 to 2016. A total of 448 medical records were analyzed and 375 (83.7%) were included. Age, gender, occupation, diagnosis, ocular and systemic diseases associated, best-corrected visual acuity, refractive error, goal to be achieved, optical, nonoptical, and electronic devices, and visual hallucination were considered. Results: Of the 375 medical record evaluated, 310 (82.6%) cases were of patients aged 80–89 years old, 218 cases (58.1%) were female and 262 cases (69.8%) were of retired patients. The age-related macular degeneration was the most prevalent disease, 296 (78.9%), followed by glaucoma in 31 patients (8.2%) and diabetic retinopathy in 9 (2.4%). Low myopia was the most prevalent refractive error, present in 148 (39.4%). A severe visual loss occurred in 145 patients (38.6%) while reading was the main goal, with 339 cases (90.4%). Optical and/or electronic devices were prescribed to 361 patients (96.2%), in a total of 418 optical and 66 electronic devices. Among the electronic devices, video magnifiers (CCTV) were indicated for 37 patients (9.8%) and handheld electronic magnifiers for 29 patients (7.7%). Visual hallucinations were reported in 11 cases (2.9%). Conclusions: This study shows that vision rehabilitation is possible in the elderly.

Tumor-associated masquerading anterior scleritis (AS) is a rare syndrome with few case reports in the medical literature. Imaging studies play a crucial role in the correct diagnosis of this entity. Ultrabiomicroscopy (UBM) is a vital imaging tool in the study of anterior segment lesions and enables early diagnosis and treatment in these patients. We report the clinical and ultrabiomicroscopic findings of a patient with tumor-associated masquerading AS due to choroidal metastases from lung adenocarcinoma. A 65-year-old male patient with stage IV lung adenocarcinoma in remission presented with red eye and intense pain in his left eye refractory to nonsteroidal anti-inflammatory drugs. An AS was diagnosed and after no treatment response, ocular ultrasound (US), and UBM were ordered. Choroidal metastases were evidenced underlying the exact area of scleral inflammation. While the characteristics of metastases by US match those previously reported in the literature, UBM reveals novel characteristics, such as irregular thickening, intralesional heterogeneity, and a “lumpy-bumpy” pattern.

Acute retinal necrosis (ARN) is an ocular inflammatory disease characterized by panuveitis and retinal vasculitis. Herpes virus is strongly associated with ARN and can often be detected by polymerase chain reaction (PCR) of vitreous samples. The authors report a case of ARN associated with herpes simplex virus-2 (HSV-2) and Epstein–Barr virus (EBV) in an immunocompetent host. A 72-year-old man with a history of herpes zoster ophthalmicus presented with sudden vision loss in the left eye in the setting of hypertensive anterior uveitis and severe vitreous inflammation. ARN was diagnosed and antiviral and steroid treatment was initiated. Vitritis improved 1 week later and foci of retinal necrosis with occlusive vasculitis were observed. Three days later, a rhegmatogenous retinal detachment developed. Pars plana vitrectomy with retinopexy was performed and a vitreous PCR test was positive for both HSV-2 and EBV. Despite retinal reattachment, visual acuity did not improve. Prophylactic antiviral therapy was continued for the fellow eye. The coexistence of more than one virus in the ARN context is exceedingly rare and might be associated with poor visual outcomes.

The current study reports three cases of both adult and pediatric patients with a history of self-limited episodes of visual symptoms following ablative procedures for cardiac dysrhythmias. Neurological and ophthalmological evaluations were always unremarkable even when performed during the episodes. The visual disturbances subsided spontaneously, and none of the patients developed any kind of permanent visual damage.

Clonazepam belongs to the benzodiazepine group of drugs and has a quick onset and prolonged duration of action. It is frequently prescribed for treatment of anxiety disorder and panic attacks. Benzodiazepines are known to induce angle closure glaucoma in susceptible eyes but acute drug induced myopia is reported only with Chlordiazepoxide usage. We report the case of a 45-year-old woman who developed acute bilateral myopia after consumption of clonazepam which resolved completely after drug withdrawal.

Purpose: To describe sociodemographic findings, frequency, and clinical characteristics of patients with corneal dystrophy who consulted an ophthalmologic national reference center in Bogotá-Colombia in 10 years. Methods: Observational, descriptive case series study was carried out. The information was obtained from reviewing medical records of patients who consulted the cornea service at an ophthalmologic national reference center in Bogotá-Colombia between 2008 and 2018. The diagnosis of corneal dystrophy was done according to the International Committee for Corneal Dystrophies classification, as well as the currently accepted specific name of the dystrophy. The type of dystrophy, clinical, diagnostic findings, sociodemographic characteristics, and type of treatment were evaluated. Results: A total of 151 eyes of 79 patients were analyzed; 68.3% of subjects were female. The mean age was 57.6 ± 18.9 years, with a range between 2 and 95 years. The median best-corrected visual acuity (BCVA) in all the groups at diagnosis was 0.30 LogMAR (interquartile range 0.5) or 20/40 Snellen. Lattice dystrophy type 1 and its variants had the worse BCVA. Fuchs' dystrophy (FD) was the most frequently identified. Regarding treatment, 80.1% (n = 121) did not require any, and 11.9% (n = 18) had a corneal transplant. Thirteen underwent penetrating keratoplasty. Of those, two had a clinical diagnosis of TGFB1 dystrophy, three of stromal dystrophy, and eight of endothelial dystrophy. DSAEK was performed in 5 eyes four had endothelial dystrophy and one had unclassified dystrophy. Conclusions: Adults and females were the most affected groups. FD was the most frequent and unclassified dystrophies were the second most frequently diagnosed. This highlights the importance of complementary studies such as optical coherence tomography of the anterior segment and genetic markers which are not currently universally available in our healthcare system. Ethical considerations: This study was approved by the Institutional Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.

Purpose: To report the demand of ophthalmic services and the prevalence of the main ophthalmic pathologies in a rural population of Costa Rica. Study Design: A cross-sectional study of all individuals seen at the ophthalmology outpatient clinic during March 2016 to February 2017. Methods: All cases presenting to the ophthalmology outpatient clinic during March 2016 to February 2017 were reviewed (n = 895 patients, 1790 eyes). Visual acuity was measured using the Snellen chart. Results: The most common reasons for consultation were decreased visual acuity in 37.7% (326/865), foreign-body sensation 20.2% (175/865), glaucoma control 5.9% (51/865), screening or follow-up of diabetes mellitus (DM) 5.8% (50/865), and blunt trauma in 5% (43/865) of patients. A total of 252 (14.1%) eyes presented with a best-corrected visual acuity (BCVA) ≤20/200; 357 (19.9%) eyes had a BCVA <20/40 and >20/200; and 1181 (65.9%) had a BCVA ≥20/40. There were 40 (4.5%) patients that had a BCVA ≤20/200 bilaterally. The most common ophthalmic findings included cataract in 552 (30.8%) eyes, pterygium in 296 (16.5%) eyes, primary open angle glaucoma (POAG) in 187 (10.4%) eyes, age-related macular degeneration in 168 (9.4%) eyes, and 131 (7.3%) eyes with diabetic retinopathy (DR). Conclusions: The most common cause of ophthalmic consultation was decreased vision, of which 14% had a BCVA ≤20/200. The common findings included cataract, pterygia, POAG, age-related macular degeneration, and DR. Seventy-five percent of bilateral visual loss is avoidable.

Introduction: The prevalence of diabetes mellitus and its complications is rising globally. Diabetic retinopathy is one of the most common microvascular complications of diabetes and is the most common cause of blindness in adults globally. The aims of this study were to determine the pooled prevalence of diabetic retinopathy in Nigeria and to identify the associated risk factors. Methods: Medical databases including PubMed, Google Scholar, African Journals online, Cochrane library, EMBASE, and SCOPUS were searched for studies on diabetic retinopathy in Nigeria between the years 2000 and 2020 using the MESH terms “diabetic retinopathy,” “prevalence,” “risk factors,”, “Nigeria.” The gray literature was also searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were strictly adhered to in selecting the studies. The outcome variables of interest were prevalence of diabetic retinopathy in Nigeria as well as risk factors associated with diabetic retinopathy. The Newcastle-Ottawa scale was used to assess the quality and bias of the selected studies. Statistical analyses were performed using Stata version 14.3. DerSimonian and Laird random-effect model was used. Heterogeneity was assessed using the I² statistic. Results: Twenty studies met the eligibility criteria and they were selected for the studies. The total sample size was 3299. I² statistic was 99%, which suggests a high level of heterogeneity among the selected studies. Using the random-effect model, the pooled prevalence of diabetic retinopathy in Nigeria was 21.3% (95% confidence interval 21.1–21.5). The most common risk factors for diabetic retinopathy in Nigeria were duration of diabetes, poor glycemic control, and hypertension. Conclusion: The prevalence of diabetic retinopathy in Nigeria is high and there is a need to improve the glycemic control of patients with diabetes so as to prevent or delay its onset.

Drug-induced acute angle closure glaucoma (AACG) is a blinding condition that requires urgent management. Unfavorable conditions encountered at the intensive care unit (ICU) represent an increased risk of developing AACG. A 60-year-old female complained of photophobia, pain, and vision loss in her right eye while hospitalized in the ICU for COVID-19 management. Symptoms developed after the use of nebulized ipratropium bromide and salbutamol, prone positioning, and darkroom conditions. The patient was discharged 3 weeks after and diagnosed with AACG the next day. Despite management with hypotensive eye drops and cataract surgery, the patient developed bilateral glaucomatous damage and vision loss in her right eye.

In this report, we discuss a case of a high myopic patient who underwent mechanical LASIK surgery in 2008 that respected the Randleman criteria for ectasia risk but incurred in a percentual thickness alteration (PTA) over 40%. The patient underwent reoperation in 2016 to correct the residual refractive error with wavefront-guided photorefractive keratectomy. At the time of the first surgery, the concept of PTA did not exist. Currently, a PTA that exceeds 35%–40% correlates with an increased risk of ectasia. We reviewed the literature focusing on the differences between the current rationale for post-LASIK enhancement and the selected strategy at the first reintervention. The purpose of this provocative case report is to emphasize the importance of personalized surgery in reoperations, always aiming for the welfare and best vision for the patient.

Purpose: To report intraocular pressure (IOP) after use of difluprednate ophthalmic solution 0.05% (Durezol^®; Novartis AG, Basilea, Switzerland) post corneal cross-linking (CXL) versus prednisolone (Pred-Forte^®; Allergan Inc., Irvine, CA, USA). Methods: A retrospective single-center case series evaluation of 34 keratoconus patients ages 16-“41 (36 eyes) who underwent CXL with Avedro's KXL System^® (Avedro Inc; Waltham, MA) between August 2016 and August 2017. Post-CXL, six eyes were given difluprednate and 30 were given prednisolone. IOP was recorded using Reichert model 30 pneumatonometer. Those that exhibited increased IOP at 3 days were given anti-glaucoma medications and changed to fluorometholone or loteprednol. Results: IOP's 3 days' postoperative (24.167 ± 5.23) in the difluprednate group were significantly higher than preprocedure (16.5 ± 2.258). In the prednisolone group, 3 days postprocedure the mean IOP (14.2 ± 3.199) was not significantly higher than preoperatory IOP mean (16.8 ± 4.232). The difference between IOP 3 days' postprocedure and before was 7.667 ± 4.546 for the difluprednate group and 2.567 ± 2.648 for the prednisolone group. These were compared using an unpaired t-test (t value = 3.750 ± 1.297) with P = 0.0007. Discussion: This study shows statistically significant difference in postoperative and preoperative IOP values after the use of difluprednate or prednisolone in young patients postCXL. Measuring the pachymetry on follow-up examinations could help see if changes in corneal thickness affect measured IOP. A controlled prospective double-blind study could confirm a greater increase in IOP following difluprednate versus prednisolone use, but due to the high risk, we do not recommend this study.

Anterior uveitis is the most common form of uveitis, with varying incidences reported in the literature. Anterior uveitis can be benign at the time of presentation; however, it often can lead to severe morbidity if not managed appropriately. The present article assists ophthalmologists in correctly diagnosing anterior uveitis and improving the quality of patient care. It is essential to go into the detailed history of the patient complaints. A thorough and detailed extraocular and ocular examination should be done. Ophthalmologists need to work up each case in a systematic manner.

We report herein a case of a 17-year-old male who presented status postmotor vehicle accident resulting in severe polytrauma and reduced visual acuity in his right eye (OD). Best-corrected visual acuity (BCVA) was 20/400 OD and 20/20 in his left eye (OS). Slit-lamp examination confirmed normal anterior segment anatomy in both eyes (OU). Indirect ophthalmoscopy and subsequent fluorescein angiography confirmed the presence of multiple cotton-wool spots, intraretinal hemorrhages, a well-circumscribed area of macular whitening, and vascular tortuosity throughout the posterior pole and peripapillary region, all suggestive of an arterio-occlusive event OD, with a normal fundus examination OS. Imaging of the macula with optical coherence tomography demonstrated hyperreflectivity of the inner retina, along with subfoveal irregularities of the outer retinal segments OD. Systemic steroid therapy was initiated, and after 1 month, BCVA improved to 20/70 OD.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly contagious pathogen, led to the coronavirus disease 2019 (COVID-19) pandemic. Ocular secretions can be one of the possible causes of SARS-CoV-2 transmission, and it should not be ignored. In the group of severe COVID-19 complications, ocular manifestations are underreported, and elucidation of ocular signs among COVID-19 patients is necessary. According to many research studies, conjunctivitis and sore eyes were the most reported ocular symptoms. Many studies have limitations such as low sample size or lack of proper findings, and much more studies need to be performed for a better inference.

Introduction: The etiologies of congenital and developmental cataracts are diverse. Most are not syndromic and have no identifiable cause, thus creating a diagnostic dilemma. We investigated the utility of chromosomal microarray in identifying the etiology of isolated childhood cataracts. Methods: Patients with congenital or developmental cataracts without other associated abnormalities received a single-nucleotide polymorphism (SNP) microarray. copy number variations (CNV) and regions of homozygosity (ROH) were compared with previous literature reports and analyzed for candidate genes to assess pathogenicity. Results: We enrolled 37 patients. The mean age of the patient population was 10.98 years old. Nineteen patients (51.4%) had bilateral cataract. Positive family history was found in 11 patients (29.7%). Eighteen patients (48.7%) had a variant on microarray: 10 (27%) with CNV, 5 (13.5%) with ROH, and 3 patients (8.1%) with both CNV and homozygosity. In five patients (13.5%), we found a potentially causative cataract gene within an ROH. Discussion: There is a high rate of notable findings among the CNV and ROH detected. Three patients were homozygous in a region known to have a cataract gene suggesting a possible autosomal recessive disease. In those with CNV, segregation would help to affirm the pathogenicity of these regions and may lead to the identification of new genes. Conclusion: SNP microarray had a surprisingly high rate of notable findings in patients with isolated cataract and may reveal the opportunities for genetic counseling, lead to discovering new cataract genes and identify additional affected genes that could lead to other clinical abnormalities.

Nanophthalmic eyes are associated with increased scleral thickness, decreased uveoscleral outflow, and increased incidence of uveal effusion syndrome, exudative retinal detachment, and angle closure glaucoma. Lamellar sclerectomies can enhance uveoscleral permeability. We report a case of nanophthalmos with exudative retinal detachment, submitted to anterior lamellar sclerectomies. A 50-year-old male patient presented with high hyperopia who complained of progressive visual loss in the right eye. The best-corrected visual acuity was 20/400 in both eyes; fundoscopy showed peripheral choroidal detachments in both eyes and retinal detachment in the right eye. Ocular ultrasound revealed thickened scleral walls and short axial lengths in both eyes. Fluorescein angiography confirmed an exudative retinal detachment in the right eye. Two inferior lamellar sclerectomies were performed in the right eye. Postoperative period was uneventful; subretinal fluid was progressively reabsorbed with retinal reattachment.

We report a rare case of polymorphic amyloid degeneration (PAD) with in vivo confocal microscopy and anterior segment optical coherence tomography (AS-OCT). A 74-year-old female presented to our service for suspected Fuchs corneal dystrophy. Her best-corrected visual acuity was 20/25 right eye (OD) and 20/20 left eye (OS). Slit-lamp biomicroscopy revealed bilateral punctate, refractile deposits in the deep stroma in an annular distribution with relative sparing of the central cornea. The remainder of the ocular examination was within expected limits. Central pachymetry was 546 μ OD and 535 μ OS. AS-OCT demonstrated focal hyper-reflective lesions in the deep stroma. Specular microscopy showed normal endothelial cell count and morphology. Confocal microscopy highlighted bright, enhancing punctate lesions in both the anterior stroma and deep stroma with normal intervening spaces. The patient was managed conservatively. Altogether, PAD is a rare, sporadically inherited condition that presents in the elderly. Confocal microscopy can aid in the diagnosis.

Purpose: By examining associations between vision loss and various types of psychopathology within the literature, this manuscript will provide ophthalmologists, psychiatrists, and psychologists insight into the relationships between vision and psychopathology to foster cross-professional relations. Design: Retrospective narrative literature review. Methods: A narrative literature review was conducted using PubMed, Google Scholar, and Scopus searches. Study types included reviews, case studies, survey analyses, population-based studies, and twin studies, among others. Topics explored include mental health consequences of vision loss, functional neurological disorders and deception syndromes, eye specific personality changes, Charles Bonnet syndrome, and vision disorders associated with psychosis. Results: Visual impairment correlates with depression and worsened overall quality of life and mental health. Visual health clinicians should improve competencies in basic suicide risk assessments in collaboration with primary care providers and mental health colleagues. When patients with functional neurological disorders or deception syndromes present, understanding their symptoms and motivations is crucial for proper management. Patients with myopia and keratoconus are anecdotally alleged to have unique personalities; however, research shows openness is the only trait correlated with myopia, while a proposed “keratoconus personality” is unfounded. The unique vivid hallucinations of Charles Bonnet syndrome typically do not bother patients and physician reassurance is usually enough to ease the anxious patient. Finally, Usher syndrome involves congenital deafness and progressive blindness in young children with links to psychosis and schizophrenia. Conclusions: The bidirectional psychosomatic ophthalmological landscape highlights a need to improve screening, recognition, and integrated treatment coordination between visual health providers and mental health providers.

The purpose of the study is to report a case of choroidal neovascularization (CNV) related to choroidal osteoma treated with intravitreal injections of bevacizumab. This was a case report in which antivascular endothelial growth factor intravitreal injections were used to treat choroidal osteoma-related CNV. A 27-year-old man with a history of blurred vision in his left eye for 15 days presented best-corrected visual acuity (BCVA) of 20/60. Fundus examination, ultrasonography, fluorescein angiography, and optical coherence tomography revealed a nasal and superior juxtapapillary choroidal osteoma with a choroidal neovascular membrane, associated with serous retinal detachment affecting the macula. After three intravitreal injections of bevacizumab, the patient improved to a BCVA of 20/30 and partial resolution of subretinal fluid. Choroidal osteoma with CNV may present a good response to bevacizumab therapy.

Hemolytic uremic syndrome (HUS) is one of the thrombotic microangiopathies characterized by intravascular hemolysis, thrombocytopenia, and end-organ damage. HUS is classified as typical (Shiga toxin producing Escherichia coli), atypical (uncontrolled complement activation), and secondary associated with other diseases. Ocular involvement is rare in atypical HUS (aHUS). Literature search using PubMed, Google scholar, Embase, etc., revealed very few case reports on ocular manifestations such as retinal detachment, putscher such as retinopathy, vitreous, and intraretinal hemorrhages, and optic atrophy that have been reported. Here, we report an atypical finding of posterior lenticonus and Grade I hypertensive retinopathy in a 13 years' boy diagnosed as aHUS with refractory hypertension who maintained stable vision after treatment with plasma exchange, mycophenolate mofetil, hemodialysis, and newer antihypertensive drugs (hydralazine).

Aims: The aim of the study is to describe and evaluate the clinical features, multimodal imaging, differential diagnoses, treatment options, and visual outcomes in patients with diagnosis of uveal effusion syndrome (UES). Materials and Methods: This was a retrospective, observational case series of patients with diagnosis of UES. Variables analyzed included age, gender, medical history, initial and final best-corrected visual acuity (BCVA), clinical features, type of treatment, and follow-up. Results: We report three cases, consisting of 2 males and 1 female, aged 37, 58, and 72 years with the diagnosis of UES. One patient was treated with medical therapy (acetazolamide) and the other two were submited to surgical treatment including one case of two-thirds thickness sclerotomy and one case with subscleral sclerectomy. All cases had complete resolution of subretinal fluid (SRF). BCVA improved in two cases, while there was no improvement of BCVA in one case due to outer retina atrophy as a consequence of chronic SRF. Conclusions: The diagnosis of UES still remains a challenge for a clinician. It is essential to know the clinical features differential diagnosis and be familiarized with the different therapeutic approaches to establish accurate diagnosis and treatment.

Introduction: The objective is to evaluate the concordance of intraocular pressure (IOP) values by comparing three tonometers; Corvis ST (COR), Icare Pro (ICA) and Tonopen (TOP) with the gold standard, the Goldmann applanation tonometry (GAT and the effect of the measurements by the central corneal thickness (CCT). Methods: One hundred and eight eyes were selected (59 patients) who underwent IOP measurement with four instruments (Icare, Corvis, Tonopen and Goldmann). An univariate analysis was applied, and then a concordance analysis was performed in which the intraclass correlation coefficient (ICC) was calculated between the different instruments taking into account the corneal thicknesses to eliminate confounding effect in measurements. Results: 109 eyes (59 patients) were included, 66% women and 34% men. Average age 52.2 years (SD 13.87). Univariate analysis was performed and a mean age 52.2 (SD ± 13.87) and mean IOP were obtained for Goldman 15 (SD ± 2.94), Icare 15 (SD ± 2.47), Tonopen 14 ( SD ± 2.85), Corvis 14 (SD ± 2.67).

Objective: The aim is to assess associated factors regarding the type of pediatric ocular trauma and final visual acuity (VA) of the patients received ophthalmology service at tertiary care facility between 2013 and 2018. Methods: Retrospective cohort study. The clinical history of patients between 0 and 15 years of age diagnosed with ocular trauma was examined. The exposure variable was the type of ocular trauma (open or closed). Other variables related to ocular trauma were studied. Results: A total of 183 ocular trauma cases were studied. The median age was 9 years (interquartile range: 5–12), most patients were males (65.5%), blunt and sharp objects were the most frequent causes of ocular trauma (41% and 33.3%, respectively). Closed ocular trauma was found in 82.5% of the cases and zone 1 was the most frequently involved (76,5%). Sixty-four percent of cases required surgical management and 26% presented complications at the final follow-up. About 78.7% of the patients had VA equal or higher than 20/40. The risk factors associated with worse visual outcome (worse than 20/40) was found to be open ocular trauma (relative risk [RR] = 5.5; 95%IC: 3.3–9.2), the affected zone (higher risk in zone 3 with RR = 7.62; 95% confidence interval: 7.61–7.63) and time elapsed between the moment of trauma and receiving ophthalmological treatment (RR = 1.01; 95%IC: 1.01–1.01). Conclusion: Most patients that presented with ocular trauma had satisfactory final VA, considering that closed ocular trauma was more frequent. Open ocular trauma, the affected zone, and the time elapsed before starting treatment were associated with worse VA outcomes in our study.

Background: Several studies have shown the correlation between ocular biometry with refractive errors. Since these parameters can be influenced by race, ethnicity, and genetics, their differences between different populations can probably explain the differences in refractive errors. We present the biometric values measured in 431 eyes with normal, short, long, and extremely long axial length (AL) from the Latin American population. Patients and Methods: All eye measurements were performed using optical biometry with IOL Master and stratified according to AL and anterior chamber depth (ACD) and evaluated in relation to each other. Symmetry between right eye (RE) and left eye (LE) was also analyzed. Setting: The study was conducted at Private practice, Guadalajara, Jalisco, Mexico. Results: ACD, white-to-white (WTW), and average keratometries (K) increase as AL increases in normal, short, and long eyes, but this correlation is not maintained in extremely long eyes. Most of the short eyes and eyes with normal AL have a normal ACD, but most of the long and extremely long eyes have an ACD >2.5 mm. In normal and short eyes, the AL and WTW are symmetric in both eyes, but in long and extremely long eyes, there are significant differences between RE and LE. ACD is symmetric in RE and LE regardless of AL. Conclusions: The importance of the ocular biometry in Latin American eyes relies on clarifying the assumptions of biometric measurements commonly used in various areas of ophthalmology including intraocular lens calculation formulas.

Susac syndrome (SS) is a rare disease affecting the microvasculature of the inner ear, brain, and retina, which usually presents with the triad of hearing loss, encephalopathy, and branch retinal artery occlusions. This condition usually affects young women and treatment consists, in most cases, of immunosuppression. In this article, we report the case of a 35-year-old female patient with an incomplete SS, with visual and hearing manifestations.

Tubulointerstitial nephritis and uveitis syndrome is an uncommon clinical entity. Usually, renal involvement is moderate, and uveitis is acute, bilateral, anterior, and nongranulomatous (revised). We present the case of a 55-year-old female patient who went to the emergency department with complaints of asthenia, myalgia, and paresthesia. One week later, she complained of photophobia and was diagnosed with bilateral nongranulomatous acute anterior uveitis. The next day, due to hypotension and acute kidney injury, the patient was hospitalized. Renal biopsy showed tubulointerstitial nephritis. The patient was started on oral prednisolone, achieving uveitis resolution and renal function stability. After slow corticoid reduction, the patient presented uveitis recurrence complicated with bilateral optic disc (revised) edema and cystoid macular edema (CME) in the left eye. After oral prednisolone reduction, the patient suffered another relapse with CME worsening. We decided to initiate methotrexate 7.5 mg/week, achieving ocular and renal function stability.

Purpose: The purpose of the study was to evaluate the contribution of orbital biopsy for the management of patients with an orbital mass of unknown etiology using the Greenwich Grading System (GGS). Methods: This was a retrospective case series conducted at a tertiary hospital over a period of 10 years (2007–2017). Case records of all patients with an orbital mass were reviewed. All relevant data collected from the medical records electronic database were analyzed. The GGS was used to assess the contribution of orbital biopsy for the diagnosis, investigation, and treatment of each patient. Results: Ninety-two medical records were reviewed; 34 patients underwent orbital biopsy. The mean age was 53 ± 26 years and 58.7% were female. In the biopsied group, the most common histopathological diagnoses were lymphoma (44.1%), nonspecific orbital inflammation (14.4%), and squamous cell carcinoma (8.8%). After the biopsy, a new diagnosis was obtained in 41.2%, although in most patients (58.8%), the biopsy confirmed the suspected diagnosis. Regarding the therapeutic management, 32.4% started a new treatment, 29.4% did not change their treatment, 32.4% altered/stopped their treatment, and 5.9% allowed reassurance and explanation for the patients. Conclusions: Orbital biopsy was considered a valuable investigation for the management of patients with an orbital mass of unknown etiology. In most cases (58.8%), the result of the biopsy confirmed the suspected diagnosis, and in around 41.2%, a new diagnosis was made. Most of the patients (64.8%) changed their treatment or started a new one based on the histopathological result.

We present the case report of a 6-year-old girl with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis associated with bilateral optic neuritis. She initially presented with disturbing behaviors and gait impairments and was hospitalized in the context of meningoencephalitis, without agent isolation and with inconclusive laboratory tests. After discharge, she noted a loss of vision with impaired color sensation and returned to the emergency department. Her best-corrected visual acuity was 20/400 in both eyes, and fundoscopy revealed bilateral optic disc edema. She was hospitalized once again. Anti-NMDAR antibodies were detected in serum and cerebrospinal fluid. The patient was successfully treated with a pulse of methylprednisolone, followed by a tapering regimen of prednisolone. She recovered to 20/20 vision in the right eye and left eye. Our report highlights additional aspects of anti-NMDAR encephalitis in children and suggests that the disease could present atypical visual manifestations, which requires multidisciplinary approaches.

The two immunosuppressants most used topically in ophthalmology are cyclosporine (CS) and tacrolimus (TL). Their mechanism of action is similar, but the TL is ten to a hundred times more powerful than the CS. We reviewed the studies found in the literature on the use of topical TL and described them, as follows, divided by indication of use. Topical TL is effective and safe against inflammatory and immunological processes of the ocular surface, although it is less powerful than corticosteroids, it has fewer side effects.

Purpose: The purpose of this study is to present a novel method of capturing and viewing stereoscopic ophthalmological pictures using the inexpensive smartphone technology applied to a common slit lamp. To assess the best perceived method for viewing this images when reconstructed. Methods: We adapted two smartphones using a fixation device for each slit-lamp ocular. By obtaining simultaneous images of each ocular, we reconstructed them in different formats. Images from a trabeculectomy bullae, corneal transplant, and glaucomatous optic nerve (GON) were rated by five independent ophthalmologists in terms of perceived image quality from 1 to 5. Results: All of the images obtained were three dimensional and of very good quality (grading 4.04 ± 0.84) in a scale from 1 to 5. Parallel-eyed images were graded with a mean of 4.5 ± 0.5, and anaglyph images were graded 3.58 ± 0.86, which was statistically lower than for parallel-eyed format (P = 0.002). Mean image quality was lower for the optic nerve and higher for the penetrating keratoplasty (PK) image, but grades did not differ significantly for the three different pictures (bullae vs. PK P = 0.18; PK vs. GON P = 0.07; bullae vs. GON P = 0.59). Conclusions: It is possible to obtain the quality stereoscopic images by combining the smartphone technology and fixation devices.

Purpose: The purpose is to identify the various causes of ocular disease and surgical interventions undertaken in children (0–18 years of age) seen during an annual ophthalmic surgical trip to Belize. Methods: A retrospective, cross-sectional review of records from seven annual surgical trips conducted by the World Pediatric Project providing pediatric ophthalmologic clinical and surgical care to Belize from 2013 to 2019 was performed. Results: The charts of 313 patients who received care during the surgical mission trips were examined. From these 313 patients, there were 545 independent clinical encounters, yielding 405 diagnoses. Patients aged 6–10 years were most commonly seen (32.1%) followed by those 2–5 years old (28.1%). The most common pathophysiology seen was strabismus/ocular motility disorder (151 diagnoses; 37.4%), followed by refractive issues (69 diagnoses; 17.1%), eyelids and/or lacrimal system disorders (53 diagnoses; 13.1%), disorders of the retina/vitreous (30 diagnoses; 7.4%), lens abnormalities/cataract (28 diagnoses; 6.9%), amblyopia (23 diagnoses; 5.7%), disorders of the cornea/conjunctiva (23 diagnoses; 5.7%), trauma (13 cases; 3.2%), conditions affecting the globe/orbit (7 diagnoses; 1.7%), other (6 diagnoses; 1.5%), and glaucoma (1 diagnoses, 0.2%). Conclusion: This study identified the most frequently diagnosed ocular conditions encountered during annual surgical mission trips to Belize. The most prevalent pathophysiology encountered was strabismus/ocular motility disorders, followed by refractive issues. The most common refractive issues encountered were myopia and astigmatism. This is the first study detailing pediatric ocular disease in Belize.

Background: Medical ministry international (MMI) is a Canadian charitable organization that coordinates healthcare missions to underserved people in developing countries. Objective: We report on the baseline clinical findings of a mission trip to Ciénaga de Oro, Colombia, present the methods used in the mission and the efforts to establish a local eye care service with long-term sustainability. Methods: Data were collected on patients seen during a 2-week mission trip from January 13 to 24, 2020. Data included eye health and the services given. Results: Altogether 5529 patients were seen by the team. Nearly 247 surgeries were performed by ophthalmologists. The most common diagnosis performed was a refractive error, for which 4066 patients (74%) received eyeglasses. Another 835 (15%) had a consultation by an ophthalmologist, of which 260 (5%) received surgery, mostly manual small incision cataract surgery and intraocular lens insertion. Conclusions and Importance: MMI is helping to reduce the prevalence of preventable blindness in the Ciénaga de Oro population; however, further training to increase the capacity of local ophthalmic services is required to improve long-term eye care to the community.