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.

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.

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.

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.