Radial keratotomy (RK) was a popular refractive procedure in the 90s. However, more reproducible laser-assisted surgeries are currently preferred. Furthermore, RK patients who undergo cataract surgery experience variable refractive and keratometric changes during the early postoperatory period. Unfortunately, those post-RK patients currently require cataract surgery. A 58-year-old male with a history of RK in both eyes (OU) presented with a 2-year history of night glare and progressive vision loss due to a subcapsular cataract in OU. Using the double-K Holladay formula, bilateral phacoemulsification was performed. At 1 week, refraction was + 2.25/-1.00/27° (power [Pwr]: 39.25D) in oculus dextrus (OD) and + 3.00/−0.75/171° in oculus sinister (OS) (Pwr: 37.41D), achieving a best-corrected visual acuity (BCVA) of 20/30 OU. At 6 weeks, refraction was + 0.75/−0.75/18° (Pwr: 39.71D) in OD and + 1.00/−0.25/180° (Pwr: 38.33) in OS. BCVA remained 20/30 OU. The resulting transitory hyperopic shift after surgery demands a careful and comprehensive intraocular lens calculation preferably aiming toward myopic overcorrection.

Lyme disease is a multisystemic infection caused by the spirochete bacterium Borrelia burgdorferi, transmitted by the tick of the genus Ixodes sp. and has three stages: primary, secondary, and tertiary. Ocular involvement is possible in any of these stages. Neuroretinitis is a rare manifestation. It is recommended that the diagnosis be performed by serology using an immunoenzymatic test, and confirmed by the Western Blot test. The recommended therapy is doxycycline 100 mg 12/12 h or 200 mg once a day for 14 days to 21 days or amoxicillin 500 mg three times a day for 14–21 days. We herein present a patient who had neuroretinitis related to a previous diagnosis of Lyme disease. The presence of neuroretinitis in a setting of Lyme disease represents a very uncommon manifestation of this particular infection.

This is a case report of a 61-year-old woman who was referred to the PUC Campinas Hospital due to a femoral fracture. Ophthalmological evaluation was requested due to complaints of enophthalmos and low visual acuity, which showed signs suggestive of an orbital tumor. Physical and complementary examinations were important for the confirmation of metastatic orbital carcinoma. Knowing that breast cancer is the most common primary tumor site involved in orbital metastasis in women, this study aimed to highlight the importance of prompt recognition and appropriate diagnostic and therapeutic management in these cases.

The German pathologist Friedrich Wegener described granulomatosis with polyangiitis (GPA), formerly known as Wegener's Granulomatosis, in 1936. Lesions are inflammatory, and typically include vasculitis, necrosis, and granulomatous changes. Ocular symptoms may be the first manifestation of this disease in 16%–58% of cases. The ocular manifestations of GPA occur in the most diverse ways. Delayed diagnosis can have serious consequences for patients' vision, as can the preservation of the globe, in addition to other systemic involvement, which can be rapidly progressive in some cases, leading to long-term disability or mortality.

Aim: The aim of this study is to determine the magnitude and severity of dry eye disease (DED) in medical students as per assessed by the questionnaire Ocular Surface Disease Index (OSDI) and Schirmer's test. Materials and Methods: A cross-sectional study of a 2-month duration involving medical students was conducted to determine the magnitude and severity of DED. Dry eye was assessed through self-administered questionnaire, Schirmer's test, and OSDI scoring. Results: The most common symptom among the participants was eyestrain in 39% (N = 31) followed by headache in 33% (N = 26). Based on Schirmer's test, 75% (n = 60) of the participants were normal, 8% (n = 6) students had mild DED, 5% (N = 4) students with moderate DED, and 11% (N = 9) students had severe DED. Based on OSDI scoring, 59% (n = 47) participants were normal, 28% (n = 21) had mild DED, 11% (N = 9) had moderate, while 2% (N = 2) had severe DED. Conclusion: In this era of digitalization, DED has engulfed the younger population who are spending greater hours on different digital devices. The prevalence of symptomatic dry eyes in our study was 41% while it was 25% based on signs. This should raise concern among the caregivers to increase awareness regarding dry eyes and give strict guidelines restricting screen time. The use of ergonomic practices such as appropriate lighting in a room, adjusting digital screen parameters (resolution, text size, contrast, and luminance), and taking frequent breaks while using the screen should be encouraged.

World Sickle Cell Awareness Day is celebrated every June 19 to raise awareness for sickle cell disease (SCD). Access to health services remains unequitable in countries affected by the disease and stigma surrounding patients hinders access to therapies. SCD is the most common severe monogenic disease in the world and is characterized by abnormal hemoglobin production. Major complications include vaso-occlusive events, hemolytic anemia, and inflammation. Microvascular events in the eye are namely responsible for sickle cell retinopathy with or without vasoproliferative changes. Methods included the electronic search of peer-reviewed English literature published until 2021, which was screened, appraised in full version, and incorporated into the review as deemed necessary. This review provides a summary of disease mechanisms and ocular manifestations, and highlights the importance of early diagnosis, close management with imaging technology, and therapeutic avenues for patients with SCD. In addition to significant healthcare barriers encountered by patients and their families, early diagnosis for SCD must be posed by physicians. It is crucial for the healthcare community to become better familiarized with the disease manifestations for early recognition and prevention of chronic complications and morbidity.

This is a retrospective case report of a male patient referred to the PUC Campinas Hospital as a victim of blunt car trauma. On ophthalmological examination, the patient had bilateral retinal changes in the foveal region, causing low visual acuity in both eyes. Knowing that ocular trauma is the main cause of legal blindness in working-age people, this study aimed to highlight the importance of ophthalmological evaluation to provide the necessary treatment and follow-up to minimize the ocular sequelae resulting from trauma.

Retrobulbar hemorrhage (RBH) is an ophthalmological complication with the potential risk of irreversible blindness due to the compressive effect on the optic nerve. Cases of patients with a history of antiaggregation and/or anticoagulation therapy and RBH have been reported in the literature; ophthalmologists should keep this antecedent in mind and consider the risk–benefit of surgery while working in conjunction with the area of anesthesia to establish the times when medication is suspended or initiated. Similarly, early and timely identification of signs and symptoms related to this complication improves patients' visual prognosis. The following describes the case of a patient who had RBH associated with the use of antiplatelet therapy.

The utility of retropupillary (RP) iris-fixated lenses, even when the iris support is deemed inadequate is portrayed in this case series. The case series emphasizes iris-claw lens as an effective alternative in cases where there is a disfigurement of the iris with meticulous surgical skills. A 58-year-old with diminution of vision in the right eye for 6 months had a vision of 6/60, iris coloboma inferiorly with zonule loss and cataractous lens. Manual small-incision cataract surgery (M-SICS) was performed with placement of iris-claw lens despite the presence of iris disfiguration. A 62-year-old male with diminution of vision in the left eye had a vision of counting fingers at 1 m. On slit-lamp examination, iris atrophy, an oval-shaped pupil with a maximum of 5 mm eccentric dilation, cataractous lens inferiorly subluxated and partially absorbed, a breach in the anterior capsule, and vitreous strands were noted in the anterior chamber. M-SICS with iris-claw lens was then performed. A 3-year-old female child with a history of trauma to the left eye had a vision of perception of light only. On anterior segment evaluation, she had radial, full-thickness corneoscleral tear with iris plugging the wound, iris trauma, and traumatic immature cataract. Left eye corneal tear repair with cataract extraction and iris-claw insertion was performed. Postoperative vision on follow-up after a month was 6/12p in all three cases. Iris claw lens being readily available, and surgical technique of insertion being easy and quick, serves as one of the effective alternatives for the intraocular lens in difficult situations.

We report a rare case of ocular cryptococcosis that presents as chorioretinitis in a patient with acquired immunodeficiency syndrome.

Ocular surface complications secondary to continuous positive airway pressure (CPAP) machines have been previously reported such as ocular irritation, dry eye disease, lid laxity, and floppy eyelid syndrome. No severe ocular complications have been specified in the literature. We report a serious ocular complication in a patient under helmet CPAP (hCPAP). A 68-year-old male with COVID-19 pneumonia required ventilatory support with hCPAP. Following 5 days, the patient started complaining of ocular discomfort, purulent discharge in his left eye, and ocular dryness upon awakening. Ophthalmological examination showed no light perception in the left eye and slit-lamp biomicroscopy revealed atalamia, loss of corneal transparency with superior infiltrates, and a total epithelial defect with iris herniation and a central perforation. Considering the patient's progressive worsening clinical condition, with a painful blind eye, left evisceration was performed. It is important to be aware of possible ophthalmological complications related to ventilation since prompt diagnosis and treatment can avoid poor visual outcomes. In this clinical case, we faced a serious ocular complication following hCPAP ventilation.

Exotropia is a cosmetically distressing strabismus with lasting negative psychosocial impact on the patient. Aim: The purpose of our study was to apply the Classification of Eye Movement Abnormalities and Strabismus (CEMAS) to the patients of exotropia (XT) in our study, identify the common types and causes of this cosmetically and psychosocially distressing strabismus, and to determine if any of these causes are preventable. Materials and Methods: A prospective, cross-sectional study was carried out in patients aged 6 months and more with exotropia attending the ophthalmology outpatient department of a tertiary care hospital from December 2016 to July 2018. Complete strabismus evaluation of the patients was done, the exotropia seen in the patients was categorized in types according to the CEMAS classification and possible causes of exotropia were studied. Results: Of the total 120 patients, 110 had comitant XT, whereas 10 had incomitant. Of the 110 comitant cases, intermittent XT was maximum – 54 (45%). A significant number of patients had XT due to sensory or neurological causes 46 (38.8%). The etiology of XT due to sensory or neurological causes included amblyopia due to uncorrected refractive errors, trauma, media opacities in cornea and lens, and posterior segment diseases. Other causes included developmental delay, congenital fibrosis of the extraocular muscles, isolated 3^rd N palsy, and basic XT. Conclusions: Our study shows that although majority of the patients had intermittent exotropia, a significant number of patients had exotropia due to visual or neurological causes, which may be preventable in many cases. Diagnosis of the cause of XT at the appropriate time may prevent unnecessary visual loss and reduce the negative psychosocial impact of squint.

Coronavirus disease (COVID)-19 is associated with ophthalmic manifestations during and after recovery from the disease and may be sight-threatening. A 54-year-old Asian Indian female patient presented to us with redness, pain, and blurred vision in her right eye (RE) of 2-day duration. In RE, the best-corrected visual acuity was 20/25, and she was diagnosed with anterior sclero-uveitis. Three days later, she had mild breathlessness and loss of taste. Nasopharyngeal swab for reverse transcription–polymerase chain reaction-COVID-19 was positive, and investigations for uveitis were negative. The systemic evaluation was also within normal limits. A month later, she had no evidence of ocular inflammation. There was no other attributable cause to her ocular inflammation. Her COVID-19 immunoglobulin G antibody was positive, confirming the previous COVID-19 infection. The case emphasizes the importance for eye care professionals to remain vigilant and considers SARS-CoV-2 as the causative agent in patients presenting with anterior segment inflammation.

Spherophakia is usually associated with systemic disorders but may also present as an isolated entity. Spherophakia patients often present in adolescence or before 50 years of age. Here, we describe a case of isolated spherophakia in a 61-year-old woman with bilateral angle closure and cataract managed by lens extraction and retropupillary iris-claw lens implantation.

Purpose: The purpose of this study is to compare analgesic, akinetic effects, and safety profile of sub-Tenon's and peribulbar anesthesia in manual small-incision cataract surgery (MSICS). Materials and Methods: In a hospital-based randomized, comparative study, patients who fulfilled inclusion criteria and who have been posted for elective surgery for uncomplicated cataracts were randomized to receive either sub-Tenon's or peribulbar block. Pain during anesthesia and surgery, akinesia, lid movements during surgery, and complications after anesthesia were assessed. Results: A total of 120 eyes of 120 patients were studied. Of which, 60 underwent sub-Tenon and another 60 had undergone peribulbar block. Pain during anesthesia was significantly less in sub-Tenon group (37/60, 61.6%) than peribulbar group (10/60, 16.6%), whereas pain during surgery was comparable in both groups, 40/60 (66.6%) in sub-Tenon group and 45/60 (75%) in peribulbar group. Peribulbar group has significantly Grade 0 akinesia (31/60, (51.7%) than 0% in sub-Tenon group. Mild complications such as chemosis 34/60 (56.7%) and subconjunctival hemorrhage (37/60, 61.7%) were more in sub-Tenon group than in the peribulbar group, 17/60 (28.3%) and 22/60 (36.7%), respectively. Conclusion: This study has shown that sub-Tenon's anesthesia provides adequate analgesia and akinesia for cataract surgery with minimal and less severe complications. Therefore, sub-Tenon's anesthesia is a relatively safe method with lesser learning curve, effective, and alternate to peribulbar anesthesia for MSICS.

Aim: The aim was to study the impact of COVID-19 pandemic on vitreoretinal practice in a tertiary care government hospital in Central India. Setting: This study was conducted at a tertiary care hospital in Central India. Design: This was a retrospective, cross-sectional, observational, comparative study. Patients and Methods: Records of all patients coming to the outpatient department of ophthalmology for vitreoretinal consultation from March 24 to September 30 in 2 consecutive years 2019 and 2020 were retrieved. Demographic profile and details of the diagnosis and treatment offered were noted and entered into the Excel sheet. Data were subjected to statistical analysis. Results: The number of patients presenting to the retina department from March 24 to September 30 came down from 1748 in 2019 to 836 in 2020, representing a 47.8% drop. Similarly, the number of major procedures was reduced from 178 in 2019 to 50 in 2020. Minor procedures such as intravitreal injections showed a reduction from 103 in 2019 to 38 in 2020 (37.2%). Conclusion: COVID-19 adversely impacted vitreoretinal practice in a tertiary care government hospital in Central India. This led to a severe loss of vision in several patients, affecting their quality of life.

Purpose: To evaluate the outcomes of our institution, the National Ocular Oncology Reference Center (Centro Hospitalar e Universitário de Coimbra) on Episcleral Brachytherapy (EBT) for the treatment of uveal melanoma (UM), since its beginning in November 2013, regarding local control, survival rates, metastatic rates, and side effects and to compare them with the international literature. Materials and Methods: Prospective study of patients referred to the Ocular Oncology Reference Center and treated with EBT between November 2013 and August 2020. Data were collected regarding local control, survival, distant metastasis, and treatment side effects. Data analysis evaluated treatment outcomes and radiation side effects. Results: A total of 150 patients underwent EBT but only 143 were considered for analysis. In 95.5% of cases local control was achieved and only 4.5% underwent secondary enucleation due to treatment failure and disease progression. Tumor initial maximum diameter was a predictor of time to melanoma-related death (Hazard ratio [HR] = 1.24 [95% confidence interval [CI] - 1.03–1.50] P = 0.018) and time to metastasis (HR = 1.43 [95% CI - 1.2–1.71] P ≤ 0.001). Among the 143 patients, the most common radiation side effect was cataract (58.33%) followed by the development of any form of radiation retinopathy (42,36%). One patient (0.7%) underwent secondary enucleation due to uncontrolled neovascular glaucoma. Conclusions: Our results demonstrate excellent clinical outcomes of local control with EBT, with satisfactory overall survival and metastasis-free survival rates, comparable to international literature. Considering the high rates of local control and globe preservation, this research validates de use of EBT as a mainstay treatment in UM.

Introduction: Trochlear apparatus calcifications can be found incidentally on computed tomography (CT) scans involving the orbit. The calcification often is misdiagnosed as intraorbital foreign body and vice versa. This study aims to find the prevalence of trochlear apparatus calcification and its association with diabetes. Methods: A cross-sectional study was conducted at a medical college hospital from January 2021 to March 2021. Two hundred and fifty-three patients undergoing CT of the brain and paranasal sinuses were recruited. The trochlear apparatus calcification is considered when attenuation is high at the point of angulation of the superior oblique muscle. Frequency and percentages were used, and Fischer's exact test was done for association. coGuide software was used for data analysis. Results: The participant's mean age was 49.16 ± 18.42 years. Out of 253 participants, 137 (54.15%) had diabetes. The prevalence of trochlear apparatus calcification was 3.95%. Out of 137 people with diabetes, 5 (3.65%) had trochlear apparatus calcification. Conclusion: The study shows that trochlear apparatus calcification prevalence was 3.95%. This benign calcification in CT should be differentiated from ocular foreign body and other pathological conditions.

Epithelial downgrowth (ED) after penetrating keratoplasty (PK) is a rare but troublesome complication, often leading to vision loss. We present a case of refractory ED and review of the literature on ED after keratoplasty. Case presentation and literature review was the study design. Intracameral 5-fluorouracil at the time of wound revision and placement of a tube implant for glaucoma control were successful in securing the closure of a fistulous wound after multiple transplant surgeries. In this case, the successful management of ED after PK was achieved with meticulous wound closure, adequate pressure control, and the mitigation of ED with chemoablation of the proliferating epithelial cells. More advanced cases may require repeated injections of antiproliferative medication, cryotherapy, or surgical excision of involved tissues.

Purpose: The coronavirus disease (COVID)-19 pandemic put medical residency programs in a predicament, impacting clinical attention and surgical practice. This study aims to describe the adjustments applied in an ophthalmology residency program to overcome the COVID-19 pandemic restrictions. Materials and Methods: An observational, comparative, and descriptive study was performed in an ophthalmology residency program to analyze the adaptations and innovations implemented to overcome the medical attention and training restrictions enforced by the sanitary authorities due to the COVID-19 pandemic in the year 2020. The residents' record folders were analyzed yearly for academic, research, clinical, and surgical activities from 2018 to 2020. An online survey was applied to residents for congress attendance, research publications, time spent on classes, lectures, clinical cases, journal club, and surgical videos sessions during the pandemic. Results: Compared to years 2018 and 2019, during 2020, there was a significant increase in the hours destined per week to academic activities (6.04 vs. 16.42 h, P < 0.001); the monthly hours of journal club sessions (0.5 vs. 3.41 h, P < 0.001); and the number of published articles involving residents (0.4 vs. 2.52, P < 0.001). On the contrary, the hours of outpatient consultation (8 h/day vs. 4 h/day) and the number of cataract surgeries performed per resident decreased (48 vs. 15, P < 0.001) from 2019 to 2020. Conclusions: Prompt reaction and innovation were required to overcome the educational and training barriers imposed by the COVID-19 pandemic. While remote academic activities increased significantly, online patient consultation and surgical simulation were necessary to avoid hindering patient's attention and surgical training.

Purpose: To report the results of using human amniotic membrane (AM) as a bandage at the end of pterygium surgery to diminish its uncomfortable postoperative symptoms. Materials and Methods: Observational, descriptive retrospective study in which patients with bilateral primary nasal pterygia were operated on with a conjunctival-limbal autograft with conventional suturing, one eye receiving an AM bandage at the end of surgery and the other not. Results: There were 20 eyes of 10 patients, five men, and five women, with a mean age of 28.7 ± 6.4 years; general postoperative symptoms (pain, burning sensation, and tearing) and foreign body sensation were statistically lower in the AM group at the 4^th, 8^th, and 12^th postoperative day (P < 0.05). Conclusions: AM as a bandage at the end of pterygium surgery reduces the uncomfortable postoperative symptoms typical of such surgery.

Myopia, as the most common source of distance vision impairment in the world, is a serious global public health and socioeconomic crisis. Although more than half of the world population will be myopic by 2050, none of the myopia control strategies has been demonstrated to completely stop the development or progression of myopia. This is due to the fact that myopia is progressing faster than its management options. It should also be emphasized that none of the current myopia control strategies is practically in use for some reason except for research purposes. It is of critical importance to realize that without any effectual controls or therapeutic interventions, myopia crisis enlarges further.

Objective: The objective of this study was to report the characteristics and the bacterial microbiological frequency of the etiological agents and the antibiotic sensitivity of the isolated pathogens in infectious keratitis in Mexico between 2012 and 2016. Methods: This was a retrospective, cross-sectional, and observational study; medical records of all patients who presented in the cornea department in Mexico with infectious keratitis from 2012 to 2016 were reviewed. Demographic data, Gram stain, and microorganisms obtained in the culture and antibiotic sensitivities were evaluated by disc diffusion test. Results: In the studied period, a total of 639 (40.67%) cases that had a positive culture were included; 54.5% were male with an average age of 48.50 ± 20.43. Gram-positive agents were the most frequent with 80.66% of cases. The most frequent causative agent was Staphylococcus epidermidis (36.61%). The most frequent Gram-negative agent was Pseudomonas aeruginosa (7.55%). The antibiotic with the highest sensitivity was netilmicin (90.3%), followed by moxifloxacin (82.3%) and gatifloxacin (81.3%). Among fortified antibiotics, ceftazidime had a sensitivity of 78% while vancomycin 43.8% (for Gram positive). Conclusion: Bacteria are the most common cause of infectious keratitis, Staphylococcus and Pseudomonas as the most common isolates. There was low resistance to netilmicin and fourth-generation fluoroquinolones for these isolates.

To report the use of intravitreal dexamethasone implant and its short-term efficacy in a pediatric patient with Coats' disease. A 7-year-old patient was referred to the clinic because of decreased visual acuity in the right eye of 10-month duration. Best-corrected visual acuity was 20/400. Funduscopic examination showed evidence of Stage 2B Coats' disease. The patient underwent treatment with laser photocoagulation, intravitreal injection of bevacizumab, and intravitreal injection of dexamethasone implant. During the 10-month follow-up, there was no evidence of side effects. Anatomical resolution was evident on funduscopic examination and macular optical coherence tomography, with best-corrected visual acuity being 20/60. Intravitreal dexamethasone implant was effective during the 10-month follow-up; providing improvement in visual acuity without any side effects.

Summary: Diabetic retinopathy (DR) is the leading cause of blindness among working-age persons in high-income countries. A public system strategy was developed to improve screening, using telemedicine, automatic detection using artificial intelligence (A/I) and medical reporting. In the current work, we evaluated program efficiency. Material: We conducted a cross-sectional study using information from an institutional database of retinographies submitted to the A/I platform in 2019. With a positive test, a medical report was made using the international scale. Results: In 2019, 220,994 retinographies were reported, corresponding to 24.0% of diabetic patients. Around half (53.0%) of cases were discarded by A/I, being different in each regional health service. The medical analysis discarded diabetic retinopathy in 30.2% of exams, 11.5% had diabetic retinopathy, including 2.3% with risk of blindness, while 3.7% could not be evaluated. Discussion: The use of A/I allowed optimizing the medical resources, discarded 53% of cases, which helped in the screening of diabetic retinopathy. Coverage is still insufficient, and detection of macular edema must be improved.

Introduction: A chalazion is a common localized lipogranulomatous inflammation of the eyelid. Histopathological diagnosis of chalazia is essential to rule out malignancy in particular sebaceous carcinoma. Our aim is to understand and classify the histopathological findings of chalazia and to determine any association with a patient's demographics. Materials and Methods: H and E sections were reviewed and classified into four categories: (1) lipogranulomas only, (2) lipogranulomas with multinucleated giant cells, (3) lipogranulomas with abscess, and (4) fibrosis without lipogranulomas or granulomatous inflammation. Patients' sex, age, and location of the lesion were analyzed. Results: Five hundred and forty cases included men (54.6%) and women (45.4%) with the mean age of 45.3 (13–89; standard deviation, 16.8). Five hundred and eight had information regarding location: left lower eyelid, 21.1%; right lower eyelid, 19.5%; left upper eyelid, 30.5%; and right upper eyelid, 28.9%. Category 1 accounted for 44.6%; category 2, 41.5%; category 3, 7.0%; and category 4, 6.9%. There was no significant correlation between classification and sex (P = 0.210) or age group (0–50 and > 50) (P = 0.369) nor between presence of giant cells and/or abscess and location (P = 0.826). Mean ages of category 1 (47.0) and 2 (43.1) were significantly different (P = 0.011). Conclusion: Four histopathological subtypes were equally distributed across sexes and eyelid locations. Individuals in category 1 are older than category 2. Favoring a systematic way to analyze the histopathology of chalazia may result in fewer missed diagnoses of malignancy and other inflammatory or infectious diseases.

Purpose: The purpose was to study the proportion and risk factors for posterior capsular rent (PCR) in small incision cataract surgery in a teaching hospital. Methods: We conducted a retrospective observational study of all cases with PCR in small incision cataract surgery performed between November 2015 and May 2018. The medical records were analyzed and data were collected. Results: There were a total of 63 cases of PCR out of 4206 cases who underwent small incision cataract surgery with a 1.68% PCR rate. The mean age was 65.5 years and the male-to-female ratio was 2.15:1. There was no association between nuclear sclerosis, pupil dilatation, and pseudoexfoliation. Resident operated surgeries had a PCR rate of 1.96 compared to faculty operated surgeries which was 1.46. Three faculty surgeons accounted for 54.3% of the cases while the remaining ten surgeons accounted for 45.7% of the cases. Postoperative day 1 vision was low, with only 19% achieving >6/18 vision, and 54% of the individuals needed more than one topical drug and 61.5% were started on oral steroids. Conclusion: Surgeon- and patient-related factors are equally important in avoiding posterior capsule rent in cataract surgeries. Patient-related factors should be carefully assessed preoperatively on slit-lamp biomicroscope, so that surgeons are prepared for all the complications and visual morbidity limited. Surgeon factors also need to be looked into and efforts have to be made to limit them and thus ensure the right to vision to each patient.

Purpose: To compare the efficacy and safety of manual small incision cataract surgery (mSICS) versus phacoemulsification in a referral center from a low-to-middle-income country. Subjects and Methods: A retrospective cohort of 177 eyes with visually significant cataract and ≤1.0 diopter (D) of keratometric astigmatism was intervened during 2017 by four surgeons either by mSICS or by phacoemulsification. Last follow-up was at 4–6 weeks. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive cylinder, spherical equivalent (SE), complications, and re-interventions. Results: The mSICS group included 107 eyes; the phacoemulsification group included 70 eyes. UDVA was comparable between both groups; 89.6% in the mSICS group and 95.7% in the phacoemulsification group achieved a UDVA ≥6/18 (20/60) (P = 0.06). CDVA was comparable between both groups; 100% in the mSICS cohort and 98.6% in the phacoemulsification cohort had a CDVA ≥6/18 (20/60) (P = 0.26). Although the absolute difference in postoperative refractive astigmatism between both groups was small, it was statistically significant in favor of the phacoemulsification group (P = 0.02). Postoperative refractive SE was also comparable between both cohorts (P = 0.64). One intraoperative complication was found in the phacoemulsification group (1.4%), with no complications in the mSICS group. However, there were six reoperations in the mSICS cohort (5.6%) and no reoperations in the phacoemulsification one. Conclusions: Both mSICS and phacoemulsification achieved excellent visual outcomes with low complication rates. Phacoemulsification gives better UDVA and lower postoperative refractive astigmatism in a larger proportion of patients at 4–6 weeks.

Iridociliary melanoma represents a rare and aggressive variant of intraocular melanoma. We report the case of a 30-year-old male with iridociliary melanoma that started as a uveitis masquerade syndrome. Noninvasive, stereotactic radiosurgery with CyberKnife^® at a dose of 27 Gy to the 90% isodose line was promptly performed. Six months after treatment, no postoperative complications were observed. The patient achieved local tumor control, maintained a 20/20 visual acuity, and no signs of systemic metastasis were observed. The versatility and outpatient nature of CyberKnife^® make it an option to consider for the multidisciplinary management of these patients.

Objective: To describe a phacoemulsification technique to face chalenging situations such as hard and leathery nucleus. Methods: The present technique was successfully performed in 52 eyes of 48 patients, over a period of 3 months. Results: None of the patients had zonular dehiscence or posterior capsular rupture. In 40 eyes, the cornea was clear on the 1st postoperative day, while in 12 eyes, the cornea cleared on the 4th postoperative day. Visual acuity improved to 20/20 (corrected distance visual acuity) at the end of the 3-week follow-up. Conclusion: The flower petal chop technique is an effective and safe technique for phacoemulsification of hard and leathery cataracts.

Paraneoplastic optic neuropathy (PON) is a rare phenomenon that is associated with lung carcinoma. In addition, retinal metastasis is extremely rare, accounting for <1% of intraocular metastasis. We hereby report a rare case of synchronous metastases from lung carcinoma to the choroid of the right eye and the retina of the left eye complicated with presumed PON. The presence of intraocular mass and optic disc swelling should prompt investigations for systemic malignancies.

Dermoid cysts are epidermis-like cysts with dermal adnexal structures such as sebaceous glands, hair follicles, or sweat glands in the cyst wall. They contain mature or immature germ cells of pluripotent origin. The usual sites of occurrence in the periorbital region include the lateral angle of the orbit, medial angle, limbal, and deep orbital region. Here, we present a case of 16-year-old female who came to the hospital with complaints of swelling in the upper eyelid and intermittent pain. After an excisional biopsy of the mass was done, the diagnosis of tarsal dermoid cyst was confirmed. Due to the paucity of cases in literature, reporting this case may help shed light on the importance of including dermoid cyst in the differential diagnosis of a tarsus-based eyelid mass.

Objective: The objective of this study was to assess the incidence of complications intra- and postoperative (until the 30^th day) of phacoemulsification surgery performed by residents of the third year, and its implications on final refraction and best-corrected visual acuity (VA), compared to those who did not exhibit any complication. Methods: This was a retrospective analysis of 300 medical records of patients who had their surgeries performed from January 2019 to February 2020 by the same three third-year residents. Fifty medical records were excluded. Initial VA logarithm of the minimum resolution angle and final VA with the best correction were analyzed, comparing whether there was a correlation with the presence of complications. Results: Of the 250 medical records analyzed, 29 (11.6%) presented complications during the intraoperative period, been posterior capsule rupture the mean one. The mean VA of patients without complications was 0.13 ± 0.17 (0.00–1.00) compared to 0.29 ± 0.28 (0.00–1.00) for those who had complications. The spherical equivalent of those without complications was −0.87 ± 0.98 (−4.38–2.00) compared to −1.19 ± 1.14 (−3.75–0.50) of the that had. Conclusion: As shown in this study, the percentage of complications is compatible with those found in the literature, also exhibits that surgeries with complications do imply in worst VA. However, when compared among themselves, before and after surgery, there was a significant improvement in the VA even in patients with complications.

Cytomegalovirus (CMV) is a double-stranded DNA virus. It is an opportunistic infection that usually affects individuals with AIDS or with profound immunosuppression. CMV retinitis is the most frequent ocular manifestation. Infrequently, this pathology has been observed in patients undergoing immunosuppressive treatment due to autoimmune diseases. This article presents a case of Crohn's disease with systemic and ocular involvement by CMV after starting treatment with infliximab (anti-tumor necrosis factor-alpha antibody).

Nanophthalmos, a congenital rare condition, is defined as a small eye characterized by hypermetropia, narrow anterior chamber, and thickened choroid and sclera. These features create an environment with high risk of developing angle-closure glaucoma (AGC) and higher risk of intraoperative and postoperative complications. This is a case of young female patient with nanophthalmos, chronic angle closure, elevated intraocular pressure (IOP) refractory to medical therapy, iridotomy, and iridoplasty, yet without glaucomatous changes. In a case of nanophthalmos refractive to medical treatment, it is challenging to decide whether lowering IOP and preventing ACG are worth the risk of vision reduction by intraocular lens miscalculation or surgical complications.

We describe the case of a 71-year-old woman with periocular tuberculosis manifesting as eyelid edema. The diagnosis of tuberculosis infection was particularly difficult given the atypical presentation, the negative result of interferon-gamma release assay, and the absence of active or past pulmonary disease. Skin biopsy and its analysis with polymerase chain reaction (PCR) enabled the definitive diagnosis of Mycobacterium tuberculosis infection. This represents an exceptionally rare form of eyelid tuberculosis and highlights the importance of a thorough investigation in the diagnostic workup of unspecified and refractory cases of eyelid edema that should include histopathological tissue analysis.

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.