Descement's membrane detachment (DMD) is separation of Descemet's membrane (DM) from the overlying stroma. It is manifested as corneal oedema at the site of detachment. With the rising number of phacoemulsification in the world, the DMD becomes an important complication that may require additional surgical intervention leading to an increase in economic as well as a social burden on the patient and hospital. Descemet's membrane detachment(DMD) is an uncommon complication of cataract surgery that may lead to corneal scarring and poor post-op vision gain. Till now, there is no standardized protocol for the management of DMD. Various authors have tried to classify DMD. Newer techniques such as AS-OCT, Schiemflug imaging, etc have helped in the early detection of DMD chance improving the prognosis.

Studies have shown that age-related macular degeneration (AMD) patients present a poor prognosis in coronavirus disease 2019 (COVID-19). These diseases have completely different etiologies and clinical courses. COVID-19 is a systemic, fast-evolving, and lethal infectious disease. AMD, in turn, is a chronic disease triggered by oxidative stress and is considered the main cause of irreversible blindness in old age. Both COVID-19 and AMD have in common the participation of immunological and inflammatory components arising from the imbalance of the redox state, responsible for the most severe phases of these diseases. Therefore, this study aims to present the triggering pathways of these diseases, as well as analyze the possible molecular mechanisms that increase the severity of COVID-19 in patients with AMD.

Importance: Large language models being approved in medical boarding examinations highlights problems and challenges for healthcare education, improving tests, and deployment of chatbots. Objective: The objective of this study was to evaluate the performance of ChatGPT-3.5 in answering the Brazilian Council of Ophthalmology Board Examination. Material and Methods: Two independent ophthalmologists inputted all questions to ChatGPT-3.5 and evaluated the responses for correctness, adjudicating in disagreements. We compared the performance of the ChatGPT across tests, ophthalmological themes, and mathematical questions. The included test was the 2022 Brazilian Council of Ophthalmology Board Examination which consists of theoretical test I, II, and theoretical–practical. Results: ChatGPT-3.5 answered 68 (41.46%) questions correctly, 88 (53.66%) wrongly, and 8 (4.88%) undetermined. In questions involving mathematical concepts, artificial intelligence correctly answered 23.8% of questions. In theoretical examinations I and II, correctly answered 43.18% and 40.83%, respectively. There was no statistical difference (odds ratio 1.101, 95% confidence interval 0.548–2.215, P = 0.787) comparing correct answers between tests and comparing within the test themes (P = 0.646) for correct answers. Conclusion and Relevance: Our study shows that ChatGPT would not succeed in the Brazilian ophthalmological board examination, a specialist-level test, and struggle with mathematical questions. Poor performance of ChatGPT can be explained by a lack of adequate clinical data in training and problems in question formulation, with caution recommended in deploying chatbots for ophthalmology.

Purpose: Ocular coloboma is defined as a congenital malformation caused by defective closure of the fetal fissure, resulting in a notch in any structure. However, the entity known as “isolated lens coloboma” does not seem to have a similar etiological basis with other ocular colobomas. This congenital malformation can induce an important decrease of the visual acuity, and facectomy has an increased risk for intraoperative and postoperative complications. Better surgical planning could be achieved with an accurate definition of the diagnosis and pathophysiology of this lens abnormality, as the extent and mechanism of zonular disease will have a significant impact on the selection of the modality of intervention. Methods: Nine eyes of seven patients, who were diagnosed with “isolated lens coloboma” and underwent phacoemulsification and implant of intraocular lens (IOL), were studied (retrospective case series). The surgeries were performed by four different surgeons, according to their preferred technique, in the last 5 years. Results: There were no intraoperative complications. Two (22.22%) eyes presented postoperative complications, one of which was the IOL decentralization. Conclusion: Considering the ocular morphogenesis and the definition of coloboma, the ideal denomination for the congenital malformation traditionally known as isolated lens coloboma would be “focal zonular dysgenesis.” The best surgical approach, contemplating the pathophysiology, in addition to the cases described and review of literature, is discussed.

White dot syndromes are a group of inflammatory chorioretinopathies that share pathologic features involving lesions in the external retinal layers and choroid. This report describes a case of acute visual loss due to a white dot syndrome superimposed on severe diabetic retinopathy (DR), leading to a challenging diagnosis. A 53-year-old man with severe DR was referred with acute unilateral vision loss, with the presumptive diagnosis of diabetic macular edema. The clinical examination and complementary diagnostic tests revealed the absence of diabetic macular edema but showed disruption of the outer retinal layers and choroidal thickening. Laboratory and imaging testing excluded other etiological factors, so an inflammatory chorioretinopathy superimposed on severe DR was considered. Following the initial presentation, without any therapeutic intervention, rapid anatomical and functional improvement was objectified. This case demonstrated that in rare cases, an inflammatory chorioretinopathy may go unnoticed in the presence of preexisting retinopathy, and the true cause of vision loss may initially be misdiagnosed.

Giant cell arteritis (GCA) is the most common primary vasculitis in adults. In general, the diagnosis is straightforward when characteristic symptoms such as headaches, scalp tenderness, jaw claudication, vision problems, or other ischemic complications are present. Atypical presentations of GCA have become increasingly recognized but we report for the first time a case of GCA presenting as partial tongue necrosis and paracentral acute middle maculopathy. This case adds to the literature and emphasizes the importance of rapid recognition of these atypical changes and optical coherence tomography in the evaluation of GCA patients.

The main purpose of this study is to describe the visual outcomes in children with bilateral cataracts undergoing small incision cataract surgery and is mainly focused on children with bilateral cataracts from poorer backgrounds who tend not to receive adequate and timely medical attention. This could lead to issues such as amblyopia. However, it is important to provide surgical care even at a later date to afford some visual redemption. When affordability is the weakest link in the treatment, a manual small incision cataract surgery (MSICS) can be an ideal manner to treat bilateral cataracts. In this study, we highlight the good visual outcome post-MSICS with polymethylmethacrylate lens implantation, primary posterior capsulotomy, and anterior vitrectomy in children with bilateral cataracts who have presented at ages beyond 5 years.

A scleral buckle is a surgical procedure used for rhegmatogenous retinal detachment repair. Different materials have been used for this technique over the years. During the 1980s, MIRAgel (MIRA Inc., Waltham, Mass) introduced hydrogel bands. This material allowed easy handling for the surgeon and self-expansion over time. A decade after their introduction, late complication reports began to appear, associated with uncontrolled expansion and the need for surgical removal. We present two complete cases and a literature review of patients presenting with ophthalmoplegia, pain, and proptosis, 25 years after hydrogel scleral buckle surgeries.

Objective: The objective of this study was to determine the frequency and main causes of visual impairment and blindness in the elderly aged 80 years or more, predominantly living in the urban area of the municipality of Maués – Amazon/Brazil. Methods: This was a cross-sectional study of a population of 360 elderly people aged 80 years or more, predominantly living in the urban area of the City of Maués-AM, who were invited to a complete eye examination along with a questionnaire to describe nutritional habits and frequency consumption of guarana. Uncorrected visual acuity, presented visual acuity, and best-corrected visual acuity of each eye were obtained. If necessary, prescription for glasses, surgery, or other types of treatment was provided free of charge. Results: A total of 360 individuals aged between 80 and 108 years (mean: 86.02 ± 5.57 years) were submitted to an ophthalmological evaluation. Of these, 182 (50.5%) were male and 178 (49.5%) female. Of the total number of eyes examined, the causes of visual impairment and blindness were cataract (51.8%), refractive errors (12.2%), age-related macular degeneration (9.1%), other nerve atrophies (3.9%), posterior capsule opacity (3.6%), glaucoma (3.5%), corneal changes (3.3%), absent globe/phthisis (3.1%), other retinal changes (1.1%), diabetic retinopathy (1.0%), pterygium (0.6%), amblyopia (0.4%), and other causes (1.8%). According to the Nutritional Screening Initiative Nutritional Dysfunction Questionnaire, 45.0% of the participants had low risk of nutritional dysfunction, 51.7% moderate risk, and 3.3% high risk. Conclusions: A high frequency of blindness (43.6%) was detected in this sample of very elderly people living in urban areas in the city of Maués. The main causes of blind eyes would be preventable with provision for cataract surgery followed by postoperative actions and prescription of glasses. Half of the elderly (50.0%) reported frequent consumption of guarana, at least once a week, but this did not prove to protect against visual impairment and blindness. These results reflect this population's limited access to eye care services, reinforcing the need for sustainable actions to improve eye health in remote areas of Brazil.

Background and Objective: Optical coherence tomography (OCT) plays a crucial role in guiding the treatment and establishing the prognosis of diabetic macular edema (DME). We aimed to determine which OCT biomarkers respond better to intravitreal triamcinolone acetonide (IVTA) switch after antivascular endothelial growth factor (anti-VEGF) treatment poor response. Materials and Methods: Fifty-eight eyes with DME, submitted to IVTA switch, were included in this retrospective study. OCT biomarkers and best-corrected visual acuity (VA) were assessed, before and after treatment with a mean follow-up of 2.9 months. Results: IVTA switch resulted in improved VA, central foveal thickness (CFT), and macular volume. Intraretinal cysts decreased or disappeared completely (P = 0.007) in 84.2% of the eyes, as well as the hyperreflective foci (P = 0.004) and the subretinal fluid (P = 0.02). Conclusion: We show that IVTA switch is an effective rescue therapy in anti-VEGF therapy refractory DME. OCT plays an important role in selecting the most appropriate treatment, namely between anti-VEGF and steroids.

Roth spots can occur as ophthalmological manifestations of systemic pathologies that compromise the retinal capillary endothelium. A case report of retinopathy due to hemolytic anemia secondary to Epstein–Barr virus is presented. Given the clinical picture, several differential diagnoses were initially considered causing Roth spots that is why a brief review of the literature is carried out to raise awareness of the diverse pathologies that can be associated with the presence of Roth spots to provide timely referrals.

Objective: The objective of the study was to assess the glycemic control and cardiovascular risk (CV risk) change in diabetes mellitus type II (DM-II) patients undergoing uncomplicated bilateral cataract phacoemulsification surgery. Design: Retrospective study. Participants: We selected 28 patients who underwent uncomplicated bilateral cataract surgery at Centro Hospitalar de Entre o Douro e Vouga between January 2018 and December 2019. Inclusion Criteria: We included patients submitted to bilateral cataract surgery without other known ophthalmological pathology. Furthermore, there were available records of their comorbidities, lipid profile, blood pressure, glycated hemoglobin (HbA1c), and body max index (BMI) prior to and in the 6 months following surgery. Materials and Methods: We assessed our patient cohort for changes in HbA1c, lipid profile, BMI, and blood pressure before and after surgery. We further subdivided our patient cohort into two different groups: group 1 – no to mild visual impairment, ≤0.48 logarithm of the Minimum Angle of Resolution (LogMAR); Group 2 – moderate to severe visual impairment, >0.48 LogMAR, and assessed for the same variables at the mentioned time points. Comparisons were done using paired samples Student's t-test or Wilcoxon rank and repeated measures ANOVA with Tukey's post hoc tests, respectively. Results: Following cataract surgery and subsequent improved visual acuity (VA), our patient cohort showed decreased HbA1c, lower arterial blood pressure, and decreased BMI, with an improved CV risk score within 6 months of cataract surgery. These improvements were more evident in the patients with worse baseline VA. Conclusions: Phacoemulsification cataract surgery resulted in improved CV risk and glycemic control in DM-II patients.

A young adult Asian Indian male presented to us with a 1-month history of trauma to the right eye (RE) with a tennis ball. He had intraocular pressure (IOP) of 32 mmHg while on three topical antiglaucoma drugs and oral acetazolamide, with uncontrolled inflammation in the anterior chamber (AC) and arteriolar occlusions in the periphery. His best corrected visual acuity was 20/20 in RE. Fluorescein angiography of the RE showed the presence of neovascularization of disc (NVD). Magnetic resonance angiography of the head and neck, and blood investigations ruled out the embolic origin of arteriolar occlusion and systemic causes for inflammation. Intra ocular pressure (IOP) and inflammation were controlled with appropriate treatment. NVD resolved with photocoagulation treatment (PRP) for capillary non-perfusion areas in 4 weeks. This case documents the occurrence of arteriolar occlusion, with neovascularization after arteriolar occlusion post blunt trauma, and successful adjunct use of topical cyclosporine in the management of AC inflammation and high IOP.

To report a rare case of orbital teratoma diagnosed in utero by ultrasound examination at 24 + 4 weeks of gestation. The fetus was delivered by cesarean section, by terminative medical indication, at 39 weeks of pregnancy, due to the possibility of dystocia caused by the size of the tumoral mass, or the risk of tumor rupture during vaginal delivery, with risk to fetal survival. The neonate, a 3 day-old female patient was examined in our Department with a large tumoral mass in the right orbit, severe proptosis, producing severe disfigurement. The diagnosis of orbital teratoma was confirmed by clinical, image, and histopathological exams. To the authors best knowledge this is the first case of orbital teratoma in Brazilian literature reporting a case where the diagnosis was made in utero, at 24 + 4 weeks of gestation.

Introduction: The increasing use of electronic gadgets (e-gadgets) has dramatically changed the adolescent lifestyle. There are rising concerns about the ill effects of the high usage of illuminated screens on vision, especially in adolescents. Objectives: The objective was to explore the pattern of e-gadget use and its association with refractive errors (REs) among adolescents. Methods: A case–control study was carried out among adolescents attending a tertiary care hospital. Adolescents with REs (cases) were compared with those without REs (controls) based on the inclusion and exclusion criteria. Two hundred matched adolescents (case-to-control ratio 1:1) were interviewed for exposure history to e-gadget use and pattern. The Chi-square test and odds ratio (OR) were calculated to find the association between e-gadget use and REs. Results: Age (17.3 ± 3.4 vs. 16.8 ± 3.3 years) and gender distribution between cases and controls were comparable. The e-gadget exposure among cases was higher than in controls (OR 1.4 P > 0.05); however, it is the duration of e-gadget exposure for >5 years was significantly higher among the cases (OR 4.6 P < 0.05). During e-gadget usage, sitting posture (OR 7.5 P < 0.05), poor lighting, indoor activity, and irregular sleep patterns were higher among cases. The purpose of using e-gadgets was predominantly for social media and browsing in cases and the educational or reading purpose among controls. Conclusion: Lesser duration, correct posture, and proper purpose of exposure to e-gadget are associated with lesser risk for REs. Results highlight the collective role of adolescents, parents, teachers, and doctors in education and lifestyle modification on e-gadget use.

Introduction: Giant cell arteritis (GCA) is a systemic disease that may cause severe visual loss. Our purpose was to determine which factors contribute to ocular manifestations (OMs) in patients with temporal artery biopsy-proven GCA. Methods: This was a retrospective review of all cases diagnosed in our center from 2010 to 2021 (>6 months follow-up). We analyzed demographic data, comorbidities, type and duration of symptoms before diagnosis, ocular features, and systemic and laboratory findings. Results: Out of 51 patients (60.8% females, mean age 74.8 ± 13.5), 32 (63%) had OM, of whom 28% had transient visual loss, 69% had permanent visual loss, and 9% had diplopia. Apart from scalp tenderness (P = 0.039), OM did not correlate with other ischemic symptoms such as jaw claudication or headache and were even significantly associated with the absence of fever (P = 0.026). Patients with OM also showed lower values of C-reactive protein (CRP) (P = 0.045). Conclusion: In our sample, visual involvement was not significantly associated with any systemic symptom apart from scalp tenderness, which highlights the importance of having a high index of suspicion for GCA in an ophthalmology setting, especially in older patients with visual loss. Furthermore, OMs were significantly associated with the absence of fever and lower values of CRP which may suggest a lower inflammatory state may in these patients.

The aim of this article was to report a well-documented case of anterior uveitis as the first manifestation of COVID-19. A 27-year-old male patient sought assistance at our emergency room complaining of bilateral painful conjuntival redness associated with photophobia for 3 weeks. These symptoms were followed by fever and chills, with a positive polymerase chain reaction for COVID-19. While his systemic symptoms improved, the ocular complaints remained. A complete panel for uveitis were performed, with negative results, except for COVID-19. The outbreak of COVID-19 in 2020 has several implications in our society. Previous reports described ocular manifestations of this condition. The ophthalmologists should be aware of the possibility of COVID-19 when facing a patient with red eye.

Introduction: Susac syndrome (SS) is characterized by microvascular occlusions in the brain, retina, and inner ear. Despite significant advances in understanding this disorder, it remains an under- and misdiagnosed entity in the clinical setting. Methods: This study was retrospective review of clinical records. Results: We present the cases of three young adults complaining of visual loss, hearing impairment, and headache. In all patients, the fundoscopy and fluorescein angiography revealed nonperfused arteriolar segments and multifocal arterial vasculitis. The brain magnetic resonance imaging demonstrated characteristic white matter brain lesions and the audiometry revealed low-frequency hearing loss. The diagnosis of SS was therefore established. We present and discuss the different treatment regimens applied and the course and outcomes of each case. Conclusion: SS is a rare and complex disease with possibly severe consequences that must be promptly diagnosed and treated. However, as no prospective or randomized controlled trials exist, empirical treatment strategies are still the norm, mainly based on the case reports and series.

Purpose: The purpose was to highlight the potential dangers of the air gun loaded with carbide commonly used by the farmers, causing injury to the eye. Scare airguns are used to prevent the birds from destroying the crops in their fields. Method: This was an observational study. Results: A 44-year-old Indian male presented to us with redness, diminution of vision, and mucopurulent discharge in his right eye (RE). On evaluation, it showed lid edema, excoriations, conjunctival congestion, corneal epithelial defect, anterior chamber inflammation, and hyphema in his RE. On his last follow-up a month later, hyphema and anterior chamber inflammation had resolved in his RE with an improved visual acuity. He was also educated about the dangers of using illegal air guns. Conclusion: Eye protection should be used when using devices that are inflammable. Ocular air gun injuries can range from some causing minor corneal abrasions to potentially serious ones. Due to the timely evaluation and treatment of our patient, the patient did not suffer significant visual morbidity.

The m.3243A>G variant in the MTL1 gene is a DNA point mutation which has been shown to cause a variety of diseases including retinal abnormalities. We report on the ophthalmologic phenotype and systemic findings in a new patient with this mutation, presenting with sensorineural hearing loss, diabetes and macular dystrophy. We characterized the retinal phenotype with a multimodal approach and throughout the follow-up period we observed sustained centripetal progression of the areas of chorioretinal atrophy.

The simultaneous occurrence of an infectious and an autoimmune systemic disorder associated with bilateral panuveitis is always feasible but improbable. While Vogt-Koyanagi-Harada requires prompt systemic corticosteroids and immunosuppressives, ocular tuberculosis (TB) requires multiple antibiotic therapies, and to a certain extent, corticosteroids to avoid inflammatory damage to crucial intraocular structures. We report a patient with granulomatous bilateral panuveitis, in which VKH and ocular TB were diagnosed simultaneously. This case emphasizes the importance of ruling out TB in the presence of a granulomatous panuveitis, despite the lack of pulmonary manifestations, especially in an endemic country. The hindmost because both diseases require different treatments.

Epibulbar choristomas are benign congenital ocular tumors characterized by abnormal growth in the epibulbar tissue, eyelids, and choroids. Two cases of epibulbar choristomas are described; the first one is a 39-year-old woman who presented a temporally conjunctival mass that had progressed in size accompanied by foreign body sensation and epiphora. Optical coherence tomography (OCT) and surgical resection were performed with a histopathological diagnosis of dermolipoma. The second case is a 7-year-old boy with a congenital corneal lesion in the nasal sector, elevated, vascularized, and with decreased visual acuity. In both cases, OCT showed a thinned epithelium with hyporeflective subepithelial fusiform lesions. OCT is an auxiliary method for the diagnosis of conjunctival lesions, such as epibulbar choristomas.

Objective: There is value in understanding the common etiologies of epiphora within different patient populations as well as identifying barriers to adequate treatment and symptom relief. The primary goal of the study is to report common etiologies of epiphora and the impact of treatment in patients of a large, inner-city hospital. Methods: This is a retrospective review of 10 years of data from the charts of 516 adult patients. The most common diagnoses and interventions linked to this symptom were evaluated. Subjective symptom improvement and adherence to follow-up were also analyzed. Results: Three hundred (58.1%) patients carried a diagnosis of dry eye syndrome and, of these, 40.1% did not have other ocular findings to explain their epiphora. Conservative management (CM) was recommended to the majority (86.4%) of the study population. 27.5% of the 357 patients who received CM as the only intervention reported symptom improvement. 90.1% of patients who underwent DCR reported symptom improvement. Nearly half of the patients were lost to follow-up. Conclusion: Epiphora is a common symptom that may be multifactorial in etiology, making effective treatment a challenge. Reflex tearing secondary to ocular surface dryness was the most common etiology linked to epiphora in this study. Low rates of follow-up limit the ability to fully assess the impact of current interventions on symptoms. Addressing the socioeconomic barriers that lower patient adherence to follow-up should allow more effective treatment of epiphora.

Purpose: The use of ergonomic practices and ergonomic environment should be encouraged to combat digital eye strain (DES) symptoms. Objectives: The objective of the study was to assess the effect of online classes on ocular health of school-going children during COVID-19 crisis. Materials and Methods: An online pretested, self-reported questionnaire with relevant details was generated through Google Forms and sent to participants. Results: The most common symptoms associated with DES in our study were eyestrain, 27.4% (N = 82), and headache, 26.8% (N = 80) (P = 0.001). There was a positive correlation of number and frequency of symptoms with increasing age and class standard of participants (P = 0.001), usage of multiple screens as well as smartphones (P = 0.004), the time spent on digital screen (P = 0.00), and continuous screen time (P = 0.004). Increasing screen distance had a negative correlation to number and frequency of symptoms (P = 0.03). Conclusion: COVID-19 pandemic has bought DES once again into limelight due its implications on overall physical, mental, and social health of adults as well as children. It is high time for a coordinated approach to spread education and promotion of ocular health in the community with emphasis on reduction of screen time, inculcation of ergonomic practices, and role model behavior of parents. This survey also gives an insight on the measures needed to be taken for safety of our children's ocular health, and therefore, it would reduce the stress faced by their parents.

Takayasu's arteritis (TKA) is a chronic, granulomatous, systemic vasculitis affecting the aorta and its branches. Ocular manifestations in patients with TKA play an important role in determining the visual prognosis. We describe a case of a young female with complaints of painless, progressive loss of vision in both eyes for 6 months who was clinically diagnosed with TKA. Her laboratory and radiological investigations confirmed the diagnosis. She had a bilateral cataract and operated for cataract in the right eye with guarded visual prognosis. This case report highlights the importance of creating awareness among ophthalmologists for early diagnosis and multidisciplinary management in cases of TKA for the prevention of blindness.

Aim: The aim of the present study was to compare the central and peripheral corneal thickness before and after cataract surgery during three postoperative visits. Materials and Methods: Prospective, comparative study was carried out among 92 patients who underwent cataract surgery in right eye. The central and peripheral corneal thickness (nasal, temporal, superior, and inferior) was measured using anterior segment optical coherence tomography before and after cataract surgery. The mean value of the corneal thickness was compared between preoperative and postoperative. Results: The central corneal thickness (CCT) showed statistically significant differences between preoperative and postoperative measurement during all follow-up visits including 3 days. We also found statistically significant differences at all locations during a postoperative visit at 3 days. Superior, nasal, and inferior points on cornea were found to have significant differences when measured preoperatively and postoperatively at 1 month. A positive correlation was established between cataract grade and CCT during a postoperative 3-day visit using Pearson's correlation. Conclusion: CCT was found to increase significantly after cataract surgery. There was a significant increase in peripheral corneal thickness right after cataract surgery.

Introduction: Glaucoma is the most common cause of irreversible blindness in the world. Although smoking has an important vascular and oxidative role in cardiovascular diseases, the association of smoking with the development and evolution of glaucoma is still controversial. In this study, we aimed to correlate smoking with the incidence of glaucoma. Subjects and Methods: A retrospective study of 442 postmortem paired donor eyes obtained from the Minnesota Lions Eye Bank of Canada (Toronto, Ont.) between 2015 and 2019 was evaluated. All donors' eyes were collected with detailed clinical history, including the glaucoma diagnosis, gender, and smoking habits. A statistical analysis and correlation between these variables were performed. Results: No correlation was found between glaucoma and smoking when the total number of smokers of both genders were examined (P = 0.258). However, male patients demonstrated a significant positive correlation (P = 0.008). This correlation was not observed when only female patients were evaluated (P = 0.077). In addition, the eyes of patients, between 70 and 75 years of age (P = 0.04) and 76 and 80 years of age who were smokers, demonstrated an increased risk of glaucoma (P = 0.027). This relationship was even stronger for males between 76 and 80 years of age (P = 0.006). Interestingly, the duration of the smoking habit showed no correlation to the development of glaucoma. Conclusion: An association of smoking and glaucoma was found in patients between 70 and 80 years of age, particularly male patients. Further investigation will be conducted examining the histopathological features and other comorbidities to better elucidate these findings.

Intracranial tumors are known to have a broad clinical spectrum. Meningiomas are the second-most common benign tumors, usually affecting women in their sixth or seventh decade of life. The World Health Organization (WHO) classified them into three grades, and Grade 1 meningiomas are considered benign neoplasias. Despite being benign, they are usually located in noble areas of the brain, most frequently in the parasagittal area, followed by the falx, the sinus cavernosus, tuberculum sellae (5%–10%), lamina cribrosa, foramen magnum, and torcular zones, and are important causes of sequelae to the patient. We herein present the case of a young patient who experienced overnight visual loss. Literature shows that several factors are related to visual recovery, which is divided into phases and occurs in approximately 23%–80% of the cases. For the WHO grade 1 tumors, the standard treatment is complete excision of the mass, and it is possible to supplement treatment with stereotactic radiotherapy in atypical, malignant, or recurrent meningioma.

Objective: The objective of this study is to report a case of superior orbital fissure syndrome (SOFS), secondary to ocular herpes zoster, with a favorable evolution. Materials and Methods: Herpes zoster ophthalmicus (HZO) usually presents with ocular manifestations, being infrequent with the ophthalmoplegia. SOFS secondary to HZO is rare. We present the case of a 72-year-old man with dermatome involvement of the first left trigeminal branch, secondary to herpes zoster infection, who also developed herpetic keratitis in the left eye. After 8 days of antiviral treatment, he developed total left eye ophthalmoplegia that required steroid treatment. The evolution of the ophthalmoplegia was favorable with resolution at 3 months of follow-up. Conclusions: It is essential to make known one of the complications of HZO infection, although not as frequent, just as important, is to recognize this pathology when it occurs for prompt management and recovery.

Objective: This study aimed to examine the frequency of atypical features in conjunctival nevi in pediatric patients referred to the McGill University Health Center-McGill University Ocular Pathology and Translational Research Laboratory and to emphasize the importance of histopathological analysis to rule out malignant lesions, such as melanoma. Methods: Forty-four pediatric patients younger than 20 years of age previously diagnosed with melanocytic lesions of the conjunctiva were included in this study, and the database was analyzed for a 10-year period (2006–2015). Clinical information such as age, gender, location, type, size, and agreement between clinical and pathological diagnosis was also recorded and presented as means and percentages. Results: The mean age was 11.3 years, of which only 9.1% were older than 18 years. Gender predilection was found toward males (52.3%). An agreement was noted between clinical and pathological diagnosis in 77.2% of cases; only 22.72% showed atypia upon histopathological examination. The most common pathological diagnosis was compound nevus with different characteristics. The atypical lesions included conjunctival melanoma, junctional nevi with atypia, compound nevi with atypia, and cystic compound nevi. Moreover, 70% of the patients with atypical lesions were males and 60% of the specimens were from the right eye. Conclusion: An impressive number of 30% of all patients had some type of atypia after histopathological analysis. Therefore, based on these results, it is of extreme importance that all melanocytic lesions are sent for histopathological analysis, so an accurate diagnosis can be established.

Introduction: Pterygium represents a significant cause of visual impairment and blindness in the Amazon and surgery is the only definitive treatment available. The cost of surgery and the need for prolonged postoperative follow-up have proved to be an obstacle to its management. The aim of this prospective study carried out in the southern region of the Amazon was to evaluate telemedicine in the pterygium surgery follow-up to help make pterygium surgery postoperative care feasible in places without ophthalmologic assistance. Materials and Methods: Postoperative follow-up care was done through teleconsultation. It involved capturing photographs from the corneal and conjunctiva by trained technicians and sending them to a reading center for an ophthalmologist's assessment based on an asynchronous (store-and-forward) model. Patients and ophthalmologists were inquired about their satisfaction regarding the postoperative follow-up. Results: All pictures were classified as adequate, allowing proper assessments of results and complications. It was possible to manage the postoperative and conclude there were no postoperative surgical complications during the 6-month follow-up. All patients reported satisfaction with the remote performed evaluation and considered that all their doubts and expectations were met. Conclusion: Teleophthalmology allows remote access and can significantly improve eye care quality, access, and affordability. It may represent an alternative to providing pterygium surgery postoperative monitoring in areas without the availability of an ophthalmologist, making it possible to combat one of the leading causes of reversible blindness in the equatorial region.

Open ocular trauma at the posterior segment can present with nonobvious scleral injuries, which represents a diagnostic challenge. The purpose of this article is to describe an atypical case of occult posterior scleral lesion. We present a clinical case of a 22-year-old man who consulted for a blunt trauma in his left eye. Physical examination revealed decreased visual acuity and vitreous hemorrhage without visualization of the posterior segment. Axial head computed tomography scan showed continuity solution of the posterior ocular wall, so the patient was taken to surgery with intraoperative atypical findings of loss of temporal retinal tissue with macular involvement, with good postoperative clinical course. In conclusion, high-energy trauma with both sharp and blunt mechanisms can generate posterior segment injuries such as occult posterior scleral rupture and even avulsion of retinal tissue in the macular area. Timely diagnosis and treatment of this type of injury is imperative for the patient's visual prognosis.

Objectives: To evaluate if the Weill Cornell Medicine (WCM) Ophthalmology Virtual Elective provided students with 1) an increased knowledge of ophthalmology, 2) an understanding of the residency program and department, and 3) an opportunity for the program faculty to become acquainted with the students. To determine how future virtual electives may be improved to increase efficacy of achieving these objectives. Methods: A 2-week virtual ophthalmology elective was offered to 4^th-year medical students. The curriculum included dedicated medical student lectures and assignments and supplemental resources from the American Academy of Ophthalmology. Students also participated in grand rounds, resident morning lectures, and delivered case presentations to the faculty. Pre- and postassessments were performed to evaluate medical knowledge, and a subjective experience survey was distributed to evaluate faculty and student experiences. Results: Seventeen, fourth-year medical students participated in the elective, and 12 students completed the voluntary pre- and postassessments of medical knowledge. Significant improvement in medical knowledge was noted. Median preassessment score was 80% (interquartile range [IQR]: 78%, 83%), and the median postassessment score was 100% (IQR: 90%, 100%), P = 0.0055. Sixteen students and four faculty members completed their respective subjective experiences in a Likert scale survey. Most students indicated they felt fairly confident or very confident that they had acquired knowledge, made relationships with faculty, and had become familiar with the program and departmental culture. All faculties indicated they agreed or strongly agreed that they were able to assess students' abilities and establish rapport with the students. Both students and faculty felt limited in the assessment of clinical skills due to a lack of in-person activities. Conclusions: Despite its inherent limitations, an ophthalmology virtual elective can effectively increase interest and knowledge within the field of ophthalmology, facilitate student–faculty relations, and serve as a tool for residency programs in the era of COVID-19 and thereafter.

Parinaud's Oculoglandular Syndrome (POGS) is a rare and atypical form of granulomatous conjunctivitis, classically composed of a triad: fever, unilateral granulomatous follicular conjunctivitis and preauricular satellite lymphadenopathy or ipsilateral submandibular, commonly related to cat scratch disease caused mainly by Bartonella henselae, or also caused, even if not tipically, by Sporothrix schenckii. In endemic areas, such as in South America, especially Brazil and Peru, ocular sporotrichosis, associated with POGS, should be considered a diagnostic hypothesis of ophthalmic diseases especially if this patient has a history of contact with cats . Itraconazole must be the first choice of medication for treatment and this patient would need assistance until complete clinical improvement, with family members oriented about possible sources of contamination, being important the early and appropriate treatment, due to the risk of eye sequelae . As a neglected public health problem in Brazil, where there has been a large increase in cases in the last decades, an accurate understanding of this disease is essential, with focus in the southeast region, mostly in the state of Rio de Janeiro.

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.