We report herein a case of a child with nephrotic syndrome (NS) who presented with acute convergent strabismus, double vision, and papilledema one week after a history of badly treated sinusitis. The imaging study revealed an extensive thrombosis of the intracranial sinuses that was treated with intravenous heparin and oral corticosteroids. Four months later, the case evolved with spontaneous resolution of ocular deviation and diplopia.

Purpose: To determine the activity of metformin in an in vitro model of posterior capsule opacification (PCO). Study Design: Experimental laboratory research. Methods: The HLE-B3 lens epithelial cell line was treated with PCO induction media (PCOM) supplemented with transforming growth factor-beta (TGF-β) and fibro-blast growth factor (FGF). Different metformin concentrations (0-100 mM) were used. The following cellular parameters were assessed: (1) survival, using a viability assay; (2) morphology, via microscopy and image analysis; (3) migration, using the wound assay; (4) and expression of epithelial (Pax6, E-cadherin) and mesenchymal (α-smooth muscle actin or α-SMA, fibronectin) markers via Western blot. Expression of the uptake receptor SLC22A1 was evaluated in HLE-B3 and in human donor eyes with Western blot and immunohistochemistry, respectively. Statistical analysis of variance (ANOVA) with Tukey post-hoc test was done for analysis of cytotoxicity, morphology and migration data. Results: Metformin was lethal to half (LC₅₀) of the cells at 30 mM, and a decrease in viability (P<0.05) was noted at 5 mM. LECs in PCOM treated with 1 mM metformin showed increased Pax6 and E-cadherin and decreased α-SMA and fibronectin expression. LECs in PCOM treated with metformin also maintained epithelial morphology. Migration was inhibited with 0.5 mM metformin (P<0.05). Both HLE-B3 and the lens epithelium in donor eyes were found to express SLC22A1. Conclusion: Metformin decreased survival and migration in LECs, maintaining epithelial phenotype and reducing mesenchymal marker expression. Metformin therefore has potential as an adjunct in PCO prevention.

Purpose: To help the ophthalmologist in the study and update of the exciting area of ocular inflammation and uveitis. Concerning the most recent clinical entities, diagnostic techniques and therapeutic options, we propose a review of the main international journals: Ophthalmology, American Journal of Ophthalmology, Retina, Ocular Immunology and Inflammation and Journal of Ophthalmic Infection and Inflammation. Methods: A descriptive bibliographic review of the papers published in 2017 in the previously mentioned journals. Results: Sorted in the following categories: pediatric uveítis, scleritis, infectious uveítis, non-infectious uveítis, diagnostic and treatment, the main outcomes are analyzed. Conclusion: Last year 2017 offers numerous papers of the highest interest and relevance in the field of ocular inflammation and uveítis. Resumen Objetivo: Facilitar el estudio de las aportaciones más relevantes en el campo de la inflamación ocular y uveítis. Se propone una revisión de las principales revistas internacionales, incluyendo: Ophthalmology, American Journal of Ophthalmology, Retina, Ocular Inmunology and Inflammation y Journal of Ophthalmic Infection and Inflammation. Método: Revisión bibliográfica descriptiva de los artículos publicados durante el año 2017 en las revistas anteriormente citadas. Resultados: De forma narrativa, se analizan las categorías de uveítis pediátricas, escleritis, uveítis infecciosas, uveítis no infecciosas, diagnóstico y tratamiento. Conclusiones: El campo de la inflamación ocular y la uveítis evoluciona a gran velocidad, y durante el año 2017 hemos sido testigos de un gran número de publicaciones de alto impacto a nivel clínico, diagnóstico y terapéutico.

Purpose: To describe a case of inferior bullous keratopathy caused by iris fibers resolved with laser diode 532. Case report: A 74-year-old woman consulted for a deterioration of visual acuity in the right eye, accompanied by foreign body sensation. A phacoemulsification surgery with IOL implant had been performed in both eyes three months before. Best-corrected visual acuity reached 20/40 in the right eye. Slit lamp examination revealed bullous keratopathy located in the inferior central quarter of the cornea of her right eye. Gonioscopy was performed to rule out having nucleus fragments in the inferior angle. With higher magnification, a pair of fine undulating fibers were observed coming from the anterior layers of the iris and making contact with the posterior face of the cornea. Photocoagulation of the iris fibers was performed with laser diode 532 and photodisruption with Nd-YAG laser, applied at the base of the fibers. After nine days, resolution of corneal edema, and disappearance of bullae was observed. Best-corrected visual acuity improved to 20/25. Conclusions: Photocoagulation of iris fibers with laser diode 532 complemented by photodisruption with Nd-YAG laser, in patients with iridoschisis, is an alternative to avoid endothelial decompensation and corneal edema, which may require corneal transplantation.

Purpose: To present a case of hemorrhagic occlusive retinal vasculitis (HORV) associated with intravitreal injection of vancomycin after pars plana vitrectomy (PPV). Methods: Single case report. Results: A 67-year-old woman presented with best-corrected visual acuity (BCVA) of 20/400 in the left eye. For clinical suspicion of chronic endophthalmitis, empirical treatment was initiated with vancomycin and ceftazidime without clinical improvement. The patient was submitted to pars plana vitrectomy. During surgery rhegmatogenous retinal detachment was observed and treated. At the end of surgery, intravitreal vancomycin was injected. After 18 days BCVA was counting fingers and fundus examination showed diffuse retinal vascular sheathing, intraretinal hemorrhages, and ischemic macular whitening. The clinical diagnosis was compatible with HORV secondary to retinal toxicity due to intraocular vancomycin. Conclusions: This case illustrates the importance of including intravitreal vancomycin during PPV surgery on the list of potential causes when investigating a case of suspected hemorrhagic occlusive retinal vasculitis.

Purpose: To describe outcomes and complications of phacoemulsification cataract surgery with intraocular lens implantation in the San Jose Hospital and explore the association between possible factors with intraoperative complications. Materials and methods: Retrospective case series. We included all the eyes undergoing phacoemulsification cataract surgery between 2010 and 2016. We excluded cases with insufficient records, cases converted to extracapsular cataract extraction by causes different of complications and those who underwent scheduled combined surgery. We described unique intraoperative characteristics of the eye, cataract hardness, intraoperative collaboration of the patient, visual and refractive outcomes and complications during the first postoperative month. The association between unique characteristics of the eye and intraoperative complications was evaluated using the chi-square test considering a p-value of less than 0.05 as statistically significant. Results: We included a total of 2047 eyes. A month postoperatively, 86.8% achieved a best-corrected visual acuity of 20/40 or better and 75.2% achieved spherical equivalent of ±1.00D. Eyes with any particular characteristic presented more intraoperative complications (p=0.01), the same as those with extremely hard cataract (p=0.003) and with deficient collaboration during the surgery (p<0.000). The most frequent intraoperative complication was rupture of the posterior capsule, and the most frequent postoperative complication was posterior capsule opacification. Conclusions: Satisfactory visual and refractive outcomes were obtained, and the incidence of complications was similar to those reported by the literature. Identification of unique intraoperative characteristics of the eye is vital due to its association with a higher incidence of complications. Resumen Objetivo: Describir resultados y complicaciones de pacientes llevados a cirugía de catarata por facoemulsificación más implante de lente intraocular en el Hospital de San José y explorar la asociación entre posibles factores relacionados con complicaciones intraoperatorias. Materiales y métodos: Serie de casos retrospectiva. Se incluyeron todos los ojos operados de catarata por facoemulsificación entre 2010 y 2016. Se excluyeron casos con registros insuficientes, convertidos a extracción extracapsular de catarata por causas diferentes a complicaciones y en los cuales se realizó cirugía combinada programada. Se describieron características especiales intraoperatorias del ojo, dureza de la catarata, colaboración intraoperatoria del paciente, resultados visuales y refractivos y complicaciones, durante el primer mes postoperatorio. Se evaluó la relación entre características especiales del ojo y complicaciones intraoperatorias usando la prueba de chi cuadrado y considerando un valor de p inferior a 0.05 como estadísticamente significativo Resultados: Se incluyeron 2175 ojos, se excluyeron 128, para 2047 estudiados. Al mes postoperatorio, el 86.8% alcanzó agudeza visual corregida de 20/40 o mejor y el 75.2% equivalente esférico de ± 1.00D. Los ojos con alguna característica especial presentaron más complicaciones intraoperatorias (p=0.01), al igual que aquellos con catarata extremadamente dura (p=0.003) y con colaboración deficiente durante la cirugía (p<0.000). La complicación intraoperatoria más frecuente fue ruptura de cápsula posterior y la postoperatoria, opacidad de cápsula posterior. Conclusiones: Se obtuvieron resultados visuales y refractivos satisfactorios y la incidencia de complicaciones fue similar a la reportada en la literatura. La identificación de características especiales intraoperatorias es importante dada su asociación con mayor incidencia de complicaciones.

Purpose: Behçet uveitis is a cause of retinal vasculitis, with fluorescein angiography being the gold-standard diagnostic exam. Optical coherence tomography with angiography (OCT-A) is a non-invasive exam that analyzes macular retinal circulation with high resolution, and therefore, could be a useful diagnostic exam in these patients. Material and methods: Analysis of 14 eyes of 8 patients with Behçet uveitis from our institution that were examined by OCT A (AngioPlex®, Zeiss). Macular morphology, area, perimeter and circularity of the foveal avascular zone, as well as central internal and global macular vascular density were evaluated. We compared our results with healthy controls. Results: Mean visual acuity in the patient’s subgroup was 0,84±0,25 and 3 eyes had previous diagnosis of retinal vasculitis with fluorescein angiography. Morphologically we found attenuation of the superficial and deep capillary plexus in 8 eyes, and in 1 of these eyes atrophy of the internal retinal layers was also found in a localized territory. In the foveal avascular area, no statistically significant changes were observed in its area and perimeter (p=0.804 and p=0.380 respectively), although we did find significant changes in its circularity (p=0.027). Vascular density was significantly altered in the internal (p=0.023) and global (p=0.028) macular parameters. Conclusion: We found changes in the macular micro-circulation in patients with Behçet uveitis, even in the absence of angiographic changes. Future studies with more patients are necessary to understand the clinical significance of these changes.

Purpose: We evaluate presenting features and treatment options of pediatric thyroid eye disease, and discuss the morbidity of this condition in the pediatric population. Methods: A retrospective chart review of 11 patients referred for evaluation of thyroid eye disease at a pediatric tertiary care facility in Miami, Florida. Results: The average age at presentation was 12.7 years. The most common ocular complaint was mild irritation. The average displacement on Hertel exophthalmometry was 21 mm for the right eye, and 21.45 mm for the left eye. Lower scleral show was the most common eyelid finding. Patients tended to be positive for thyroid stimulating immunoglobulin and thyroid peroxidase antibody. Conclusion: In contrast to thyroid eye disease in adults, the condition tends to present with mild ocular findings in children. Pediatric patients presenting with thyroid eye disease respond very well to medical therapy aimed at enhancing the altered ocular surface.

Background: Iridoschisis is a rare condition characterized by the thinning and cleavage of the anterior stroma of the Iris; usually bilateral and associated with narrow angles, ocular hypertension and glaucomatous optic neuropathy. We report the case of three Latin American patients with iridoschisis; all of them associated with narrow angles, and one with history of chronic angle closure glaucoma. The patients had no previous history of ocular trauma or inherited ocular disease. As a new finding, we present a case of unilateral hyphema as the presenting sign of this entity. Conclusions: Chronic open-angle glaucoma, as well as intermittent angle-closure glaucoma, should be excluded in all patients with iridoschisis, and regular follow-up should be established after diagnosis. After having presented an unusual way of presentation such as unilateral hyphema (with no previous documented reference of this sign), we have widened the spectrum of clinical findings for the suspicion and diagnosis of this pathology.

Introduction: Vision is one of the primary forms of interaction with the environment, and its loss is a stressful situation, even more dramatic when it is due to trauma, a sudden and unexpected event. Ocular trauma is a frequent reason for consultation in ophthalmology; however, in our environment, there are no clear and sufficient statistics about it. Methods: Observational descriptive study. We reviewed the medical records of patients with open ocular trauma assessed at the Hospital de San José, between March 2013 and February 2016, with a minimum follow-up of 2 months. Results: We measured the time from the trauma to admission to the hospital (an average of 24 hours), the time between the trauma and the first surgical procedure (34 hours on average), and the time between the patient’s admission to the institution and the first surgery (an average of 11 hours). Eighty-five percent of the patients presented laceration-type open ocular trauma and of this, 92.4 % corresponded to penetrating trauma. On admission, the worst visions corresponded to patients with trauma in zone III and / or with ocular rupture. Discussion: It has been described that the time from the trauma to the primary repair surgical procedure is a prognostic factor for the final visual acuity and the development of endophthalmitis, and we found out that in our patients this time is slightly longer than other reports, probably due to the difficulty of patients to access medical care in our environment. On the other hand, the final visual acuity is affected by multiple factors, so it is variable among the different studies; however, the visual results of our patients do not vary significantly concerning those reported in the literature. Resumen Introducción: La visión es una de las principales formas de interacción con el medio y su pérdida es una situación estresante, aún más dramática cuando es debido a trauma por ser un evento súbito e inesperado. El trauma ocular es un motivo de consulta frecuente en oftalmología, sin embargo, en nuestro medio no existen estadísticas claras y suficientes sobre este. Métodos: Estudio observacional descriptivo. Se revisaron las historias clínicas de pacientes con trauma ocular abierto valorados en el Hospital de San José, entre marzo de 2013 y febrero de 2016, con un seguimiento mínimo de 2 meses. Resultados: Se midió el tiempo desde el trauma hasta el ingreso al hospital, en promedio 24 horas, el tiempo entre el trauma y el primer procedimiento quirúrgico, de 34 horas en promedio y el tiempo entre el ingreso del paciente a la institución y la primera cirugía con un promedio de 11 horas. El 85% de los pacientes presentó trauma ocular abierto de tipo laceración y de estos el 92.4% correspondió a trauma penetrante. Al ingreso las peores visiones correspondieron a los pacientes con trauma en zona III y/o con ruptura ocular. Discusión: Se ha descrito que el tiempo desde el trauma hasta el procedimiento quirúrgico de reparación primaria es un factor pronóstico para la agudeza visual final y para el desarrollo de endoftalmitis. Encontramos que en nuestros pacientes este tiempo es levemente mayor a otros reportes, probablemente debido a la dificultad de los pacientes para acceder a la atención médica en nuestro medio. Por otro lado, la agudeza visual final se ve afectada por múltiples factores, por lo que es variable entre los diferentes estudios, sin embargo los resultados visuales de nuestros pacientes no varían de forma importante respecto a los reportados en la literatura.

Introduction: The models of medical care in the world reflect the relationship between the different actors of the health system and the people who live in the community, based on relationships of trust and help, whose objective is to achieve the biopsychosocial well-being of the people, families and communities, which implies a holistic vision of health care. In the Second Hospital of Anhui Province in China, an ophthalmological eye care model was implemented in rural communities free of charge and accessible with timely diagnosis and personalized medical-surgical treatment to improve the quality of ophthalmological care. Method: A clinical-surgical ophthalmological eye care model was applied in four rural communities in the province of Anhui (Huainan, Wuhu, Xuancheng, and Luan) from 2013 to 2017. The ocular affections found in the different districts visited were refractive disorders, senile cataract, myopia, diabetic retinopathy, pterygium, non-surgical strabismus and lacrimal obstruction. There was a car equipped with high technology, and that complied with the requirements for clinical and surgical procedures. The ophthalmology team consisted of 6 members (4 doctors, one graduate in optics and optometry and one engineer in electromedicine). Coordination was established with the Board of Directors of our hospital, the Department of Labor and Social Security, with the local governments and health centers of the places to visit. Results: Of the total number of patients seen in the office (7075), 57.3% corresponded to the male sex, aged 60 years and over. Patients with a diagnosis of senile cataract represented 2031 cases seen (28.7%); of them, 1754 had a surgical solution (81.4%). The left eye was the most operated and the IOL implanted was the foldable one. Minimal complications were reported such as rupture of the posterior capsule and endothelitis, the most frequent of which did not exceed 1%. Patients with diabetic retinopathy occupied 28.7% of the total cases seen. The non-proliferative diabetic retinopathy prevailed in the patients studied; however, 296 patients presented the proliferative form (17.8%) and eight patients presented with clinically significant macular edema. Conclusions The model of ophthalmological care that was implemented in the rural areas of the province of Anhui, free of charge and accessible, guaranteed the clinical diagnosis and the adequate clinical and/or surgical treatment of the most frequent ocular conditions presentede there such as senile cataract, pterygium. , myopia, diabetic retinopathy, thus raising the quality of the ophthalmological care of patients, family, and local community. Resumen Introducción: Los modelos de atención médica en el mundo reflejan la relación entre los distintos actores del sistema de salud y de las personas que viven en el territorio, basada en relaciones de confianza y ayuda, cuyo objetivo es lograr el bienestar biopsicosocial de las personas, familias y comunidades, lo que implica una visión holística del cuidado de la salud. En el Segundo Hospital de la provincia de Anhui en China, se implementó un modelo de atención oftalmológica en las comunidades rurales de forma gratuita y accesible con el diagnóstico oportuno y el tratamiento médico quirúrgico personalizado para elevar la calidad de la atención oftalmológica. Método: Se aplicó un modelo de atención oftalmológica clinico- quirúrgico en cuatro comunidades rurales de la provincia de Anhui (Huainan, Wuhu, Xuancheng y Luan) desde el año 2013 hasta 2017. Las afecciones oculares encontradas en los distintos distritos visitados fueran trastornos refractivos, catarata senil, miopía, retinopatia diabética, pterigion, estrabismo no quirúrgico y obstrucción de vías lagrimales. Se disponia de un carro móvil equipado con alta tecnología y que cumplia con los requerimientos para procedimientos clínicos y quirúrgicos. El equipo de oftalmología estuvo integrado por 6 miembros (4 médicos, 1 Licenciado en óptica y optometría y un ingeniero en Electromedicina). Se estableció coordinación con el Consejo de Dirección de nuestro hospital, el Departamento de Trabajo y Seguridad Social, con los gobiernos locales y centros de salud de los lugares a visitar. Resultados: Del total de pacientes vistos en consulta (7075), el 57.3 % correspondía al sexo masculino, con edades de 60 años y más. Los pacientes con diagnóstico de catarata senil representavan el 28,7%, con 2031 casos vistos; de ellos, 1754 tuvieron solución quirúrgica (81.4%). El ojo izquierdo fue el más operado y la LIO implantada fue la plegable. Se reportaron mínimas complicaciones como la ruptura de la cápsula posterior y endotelitis, las más frecuentes que no superaran el 1%. Los pacientes con retinopatía diabética ocuparon el 28.7% del total de casos vistos. La retinopatía diabética no proliferativa predominó en los pacientes estudiados; sin embargo, 296 pacientes presentaron la forma proliferativa (17.8%) y 8 pacientes presentaron con edema macular clínicamente significativo. Conclusiones: El modelo de atención oftalmológica que se implementó en las zonas rurales de la provincia de Anhui de manera gratuita y accesible, garantizó el diagnóstico clínico y el tratamiento clínico y/o quirúrgico adecuado de las afecciones oculares más frecuentes que fueran catarata senil, pterigion, miopía, retinopatía diabética, elevando así la calidad de la atención oftalmológica de los pacientes, la familia y la comunidad local.

Purpose: To obtain feedback on the behavior of glaucoma patients with their treatment and identify factors that may be related to the adherence to treatment in a reference ophthalmological center in Bogotá - Colombia. Method: A cross-sectional study was conducted, including 105 patients who attended the glaucoma consultation at the Fundación Oftalmológica Nacional, between April 2010 and June 2011. Results: The distribution with respect to gender was similar, 53.3% were men. The average age was 64.8 years (range 25-88 years). The level of education was similar in the different groups: primary 34.3%, high school 35%, professional 29.9% 67.7% of the patients documented adherence to treatment; of these, 91.4% have a stable provider of the drops, in 53.3% drops were provided by their health insurance, in 37.1% drops were purchased by the patient, in 5.7% were supplied as a medical sample by the ophthalmologist and 3.8% responded that they not have a stable provider for the drops. Gender was not associated with adherence to treatment (p=0,53). No statistically significant association was found between adherence to treatment and educational level (p=0,56), whether or not the information provided by the treating physician is understood (p=0,314) or the number of bottles required for the treatment (p=0,75). Patients who had a stable provider of the drops had greater adherence to treatment (p <0.001). The stable provider of the drops is a protective factor for adherence to glaucoma treatment (OR 0.26 CI 0.186-0.365). Conclusion: We can conclude that the main cause of non-adherence to topical treatment of glaucoma or intraocular hypertension in our country is not having access to medication. It will be interesting to analyze the impact of the new medication delivery system introduced by our health authority on the adherence to chronic treatments in ophthalmology. Resumen Propósito: Obtener retroalimentación de la conducta del paciente de glaucoma con su tratamiento e identificar qué factores puedan estar relacionados con la adherencia al tratamiento en pacientes de un centro oftalmológico de referencia en Bogotá - Colombia. Métodos: Se realizó un estudio transversal, que incluyó a 105 pacientes que acudieron a la consulta de glaucoma en la Fundación Oftalmológica Nacional, entre abril de 2010 y junio de 2011. Resultados: La distribución con respecto al género fue similar, el 53.3% fueron hombres. La edad promedio fue 64,8 años (rango 25-88 años). El nivel de escolaridad fue similar en los diferentes grupos: primaria 34,3%, bachillerato 35%, profesional 29,9%. El 67,7% de los pacientes documentaron adherencia al tratamiento; de estos, el 91.4% tiene un proveedor estable de las gotas, en el 53,3% las gotas fueron suministradas por su seguro médico, en el 37,1% fueron compradas por el paciente, en el 5,7% fueron suministradas como una muestra médica por el oftalmólogo tratante y el 3,8% respondió que no tienen un proveedor estable para su medicamento. El género no se asoció con la adherencia al tratamiento (p=0,53). No se encontró asociación estadísticamente significativa entre la adherencia al tratamiento y el nivel educativo (p=0,56), si se comprende o no la información proporcionada por el médico tratante (p=0,314) o el número de frascos requeridos para el tratamiento (p= 0,75). Los pacientes que tenían un proveedor estable de las gotas tenían una mayor adherencia al tratamiento (p <0.001). El proveedor estable de las gotas es un factor protector para la adherencia al tratamiento del glaucoma (OR 0.26 CI 0.186-0.365). Conclusión: Podemos concluir que la causa principal de la no adherencia al tratamiento tópico del glaucoma al de la hipertensión intraocular en nuestro país es no tener acceso a la medicación. Será interesante analizar el impacto del nuevo sistema de dispensación de medicamento implementado por nuestra autoridad de salud sobre la adherencia a los tratamientos crónicos en oftalmología.

Viral conjunctivitis, mainly caused by Adenovirus, is currently a health problem to be solved. The increase in infection in recent years and the morbidity that can be associated despite treatment, make it an infectious disease whose knowledge and study is essential for the ophthalmologist. An exhaustive bibliographic review of the main articles published was carried out using the keywords: hemorrhagic conjunctivitis, epidemic keratoconjunctivitis, and adenovirus conjunctivitis, with the aim of discussing the main features, the new diagnostic methods, treatments, quitar and possible complications and clinical implications of the epidemic keratoconjunctivitis. Resumen La conjuntivitis viral, principalmente causada por Adenovirus, es actualmente un problema de salud a resolver. El aumento del contagio en los últimos años y la morbilidad que puede asociarse a pesar del tratamiento hacen que se trate de un cuadro infeccioso cuyo conocimiento y estudio es esencial para el oftalmólogo. Se realizó una revisión bibliográfica exhaustiva de los principales artículos publicados utilizando las palabras clave: conjuntivitis hemorrágica, queratoconjuntivitis epidémica y conjuntivitis por adenovirus, con el objetivo de discutir las principales características, los nuevos métodos de diagnósticos, tratamientos y posibles complicaciones e implicaciones clínicas de la queratoconjuntivitis epidémica.

Plasmablastic lymphoma (PBL) is a subtype of a rare and aggressive, non-Hodgkin’s lymphoma. It is usually associated with immunosuppression, HIV, or Epstein Barr virus and with a poor prognosis. It is characterized by a loss of the typical markers of mature B cells such as CD20 and expression of activated B-cell immunopheno-types associated with plasma cells. We present a case report of an HIV negative 21-year-old male with plasmablastic lymphoma of the right lower eyelid who underwent surgical resection and chemotherapy. Given the minimal accounts of PBL in the eyelid, the authors attempt to review the literature and cross match similarities with previous accounts of ocular involvement related to this malignancy.

A 43-year-old man presented with a decrease of vision in the left eye after blunt ocular trauma. Visual acuity was of 20/20 in the right eye and 20/100 in the left eye. Fundus examination revealed a choroid rupture and submacular hemorrhage. Three months after the trauma, it was evident the development of choroidal neovascularization (CNV). A serie of intravitreal injections of ranibizumab were initiated. The optical coherence tomography angiography (OCTA) demonstrated to be better than fluorescein angiography (FA) to show evidence of CNV, and was essential to follow up the progression and guide therapeutic decisions. Decision for treatment based on OCTA findings lead to an excellent visual acuity outcome with visual acuity of 20/25 seven months after the trauma.

Introduction: The increasingly demanding modern life and the need not to depend on the glasses, make patients seek for surgery to improve their quality of life, based on visual quality. Different quality of life tests are adaptable to ophthalmology. The use of the NEI VFQ questionaire allows to access the clinical response and the degree of patient satisfaction, elements that corroborate with psychophysical studies. Material and method: A prospective longitudinal descriptive study was conducted on 70 presbyopic hyperopic patients, submitted to surgery from January to December 2016, to whom the NEI VFQ-25 questionnaire, chromatic sensitivity, stereopsis and contrast studies were carried out. pre and post surgery. For the processing of statistical information, the SPSS version 11.5 program for Windows was used. Results: Pacients average age was 54.67 years, predominantly female and Caucasian. There was an evident improvement of the vision and the quality of life, in the chromatic discrimination and the sensitivity to the contrast, as well as the stereopsis. All the elements explored by the test were better in the postoperative period, with a score of 93.25 points as a total result, being statistically significant. Conclusions: Presbyopic hypermetropic patients, operated with refractive lensectomy, clinically and statistically improved their quality of life relative to visual function. Resumen Introducción: La vida moderna cada vez más exigente y la necesidad de no depender de los espejuelos, hacen que los pacientes busquen la cirugía para mejorar su calidad de vida, basada en su calidad visual. Diferentes test de calidad de vida son adaptables a la Oftalmología, el uso del NEI VFQ permite conocer la respuesta clínica y el grado de satisfacción del paciente, elementos que se corroboran con estudios psicofísicos. Material y método: Se realizó un estudio descriptivo longitudinal prospectivo a 70 pacientes hipermétropes présbitas, operados en el periodo de enero a diciembre 2016 a los que se les aplicó el cuestionario NEI VFQ-25, se realizaron estudios de sensibilidad cromática, estereopsia y contraste, pre y postcirugía. Para el procesamiento de la información estadística se utilizó el programa SPSS versión 11.5 para Windows. Resultados: La edad promedio fue de 54,67 años, predominó el sexo femenino y color de la piel blanca. Hubo una mejoría evidente de la visión y la calidad de vida, en la discriminación cromática y la sensibilidad al contraste, así como la estereopsia. Todos los elementos explorados por el test, fueron mejores en el postoperatorio, con un puntaje de 93,25 puntos como resultado total siendo un estudio clínico y estadísticamente significativo. Conclusiones: Los pacientes hipermétropes présbitas, operados de lensectomía refractiva mejoraron clínica y estadísticamente su calidad de vida relativa a la función visual.