Objective: The objective was to describe a case of ocular myasthenia gravis (MG) in a pediatric patient. Design: This is a descriptive, retrospective study and case report. Methodology: For the purpose of the case report, we searched and analyzed the literature referring to the diagnosis and treatment of ocular MG (OMG) in children. Description: A previously healthy 5-year-old girl presented to the emergency room because of sudden-onset ptosis of the right upper lid without other symptoms. Her examination demonstrated fluctuating ptosis and limitation to downgaze in the right eye. Because of the fluctuation of the ptosis, OMG was suggested, and the patient was tested with ice-pack test and neostigmine test with positive results. Treatment with pyridostigmine was initiated with a good response. Discussion: OMG has a very low incidence in pediatric patients. It is a disorder characterized by impairing neurotransmission at the neuromuscular junction that generates extraocular muscle weakness. It is important that ophthalmologists have knowledge about this disease because it is a differential diagnosis when there is a patient who has ptosis, strabismus, or limitation of movements. There are no standard diagnostic criteria for this disease; the diagnosis is based on clinical presentation and pharmacologic, serologic, and electrophysiologic tests. The treatment is based on steroids and anticholinesterase drugs. Some patients will require plasmapheresis or immunomodulators.

A unilateral nonteratoid malignant ciliary body medulloepithelioma presented in a 13-year-old girl as a leukocoria with an extense vascularized retrolental membrane in her right eye. In this description, clinical documentation, posterior segment ultrasound, and ultrasound biomicroscopy were obtained, and an anatomopathological correlation was made by showing rosettes in some histological cuts stained by haematoxylin and eosin obtained from the mass and the membrane.

The study objective was to present multimodal imaging of definite ocular sarcoidosis (OS) in a young adult. A 52-year old woman consulted for 5 days of photophobia, ocular pain on movement, and redness in her left eye. Slit-lamp examination showed bilateral inferior granulomatous keratic precipitates, high cellullarity in the anterior chamber, posterior synechiae and hypopigmented subretinal lesions in the inferior vascular arcade, and nasal retina. In addition to the complete ophthalmic examination fundus photography (FP), fluorescein angiography (FA) and optical coherence tomography-angiography (OCT-A) were performed.Multimodal imaging of both eyes of the patient was performed. FP showed periphlebitis, hypopigmented subretinal lesions in the inferior temporal vascular arcade, and nasal retina. FA showed late diffuse capillary leakage from the subretinal lesions and optic nerve. OCT-A showed decreased choroidal capillary density, small hypo-intense gray areas of retinal capillary hypoperfusion, and presence of confluent and isolated areas void of flow in the deep plexus and choriochapillaris. With these findings on the multimodal imaging, chest computed tomography scan, and negative laboratory workup for other diseases, a presumptive diagnosis of OS was made which was subsequently confirmed with a positive skin nodule biopsy. The combination of OCT-A and other diagnostic methods allows a more detailed evaluation of structural and functional clinical findings in OS. There are few studies on OCTA findings in OS. Further studies with larger samples are needed in order to establish specific OCTA findings that could be used as diagnostic criteria.

Giant molluscum contagiosum (MC) is a rare nodular presentation of molluscum lesions. A diameter measuring more than half to 1 cm qualifies to be called as a giant MC. It has a strong predilection toward immunocompromised patients. A 45-year-old retropositive male presented with a large left upper eyelid swelling. After clinical evaluation, it was presumed to be a chronic lid abscess. On excision biopsy surprisingly, no purulent matter was obtained. A nodular mass was discovered which was confirmed to be giant MC on histopathology. No recurrence was found on follow-up. In immunosuppressed patients, MC has a chronic course and can rarely become large as a giant MC. CD4 lymphocytopenia and a phenomenon known as immune reconstitution inflammatory syndrome probably contribute to its pathogenesis. Giant MC must be kept in mind while evaluating an immunosuppressed patient coming with large lid swellings.

The purpose of the study is to present a case of indirect carotid cavernous fistula (CCF) successfully treated with endovascular approach. A 46-year-old male presented with a progressive, painless visual loss and conjunctival injection of the right eye with 1 month of evolution. On ophthalmology examination, the patient had best-corrected visual acuity of 20/30 in the right eye and an intraocular pressure (IOP) of 20 mmHg. The patient still had pulsating proptosis and an orbital bruit on the auscultation. Slit-lamp examination revealed corkscrew episcleral vessels. The patient was submitted a magnetic resonance angiography that confirmed the presence of an indirect carotid-cavernous sinus fistula. The patient was submitted to endovascular embolization by the transarterial approach to close the fistula with complete clinical and imaging resolution. Two months after the procedure, the visual acuity was 20/20, and the IOP was 8 mmHg. CCF is an uncommon disease and may be misdiagnosed when there are few signs and symptoms on presentation. Different subtypes of CCF cause different clinical signs, with varying speeds of onset and severity. The diagnosis is based on clinical findings and by imaging studies. However, the definite diagnosis is only possible with cerebral angiography. It is important to consider risks and benefits in relation to endovascular treatment, mainly in indirect CCF.

Here, we report the case of a 16-year-old patient with lesions on the upper eyelids, which were diagnosed as granuloma annulare. This is an uncommon site of presentation of this lesion type, which is more commonly found on the extremities such as the hands, ankles, and trunk. Excisional biopsy of the lesion was performed, and the patient presented with recurrence. The patient was started on systemic treatment and showed improvement of the clinical picture and reduction of the lesions, with continuous follow-up.

Pinguecula is a common disease in tropical countries however there are not so many published articles regarding its aetiology, signs , symptoms and management . It seems that Ultraviolet rays play an important role and it is one of the reasons that explain the prevalence in zones near the equator. Pingüeculas behave different in the nasal than in the temporal side playing an important role in the development of pterygium which explains the high incidence of its nasal location. Regarding treatment and management , there are different approaches that will discussed in this mayor review.

We report a case of visual alterations after the first use of poppers in a young male patient. A 32-year-old male patient with no past medical history presented with decreased central visual acuity and phosphenes in both eyes. He admitted the use of poppers a day before the symptoms began. Optical coherence tomography showed bilateral disruption of the ellipsoid zone. Poppers' use is increasing in young people and so is the possibility of visual and structural alterations that can persist over time as a result of macular toxicity.

Introduction: Cataracts remain the leading cause of blindness worldwide. Despite this, there is a lack of information surrounding cataracts in Ecuador. We sought to assess the rate and barriers to cataract-related care in two Ecuadorian communities to identify points of intervention for local and international organizations. Methods: This was a cross-sectional assessment using a convenience sample of patients seen in clinics run by Fundacion Internacional Buen Samaritano Paul Martel, a local nonprofit providing affordable eye care in Ecuador. Two populations were assessed. Week 1 patients were from the Andean region of Chimborazo (W1) and week 2 patients from Santa Cruz Island, Galapagos (W2). All patients seen were assessed for cataracts. Patients identified as having cataracts completed a six-question survey related to barriers to care. The primary outcomes were the rate of cataracts and the leading barriers to care. Results: Forty-four total patients during W1 and 1,002 during W2 were seen and screened for cataracts. Mean age (years) was W1 – 44 years and W2 – 42 years. The overall rate of cataracts was 4 (9%) in W1 and 50 (5%) in W2. When stratified by age, the rate of cataracts in individuals aged 50 and over was 21% (W1) and 6% (W2). Forty-six participants with cataracts completed the survey. The major barriers to cataract-related care were cost (n = 26), followed by access (n = 7), and fear of surgery (n = 4). Conclusions: Our results confirm the high overall rate of cataracts in patients presenting to eye clinics in two distinct communities. We found that cost and access are the main barriers to care. These communities would benefit greatly from care delivery models that bring services close to where individuals live, through partnerships between local and global organizations.

The hypohidrotic ectodermal dysplasia (HED) is a rare genetic disease characterized by the absence or deficiency function of the ectodermal derivatives. Ocular involvement includes dry eyes, cataract, blefaritis, and alterations of meibomian glands. However, keratoconus has not been included as a manifestation in the literature. We report the case of a 17-year-old male who presented HED and keratoconus, an ocular manifestation seldomly related to this syndrome. The patient was submitted to a contact lens fitting, and the final visual acuity was 0.1 logMAR in both eyes. Therefore, to the best of our knowledge, our patient can be considered the fourth patient diagnosed with keratoconus and HED simultaneously worldwide. The uniqueness and rarity of this syndrome associated with keratoconus, as well as the satisfactory contact lens fitting, motivated this case report, which can provide useful information and alert to this possible etiological association.

A 22-year-old female patient was diagnosed to have HIV and treated by highly active antiretroviral therapy (HAART) since 2012 had developed a reduction of vision in both eyes secondary to cataract. The cataract was extracted from both eyes with no immediate postoperative complication. During follow-up, it was recognized that she had had bilateral Stage 3 macular hole in both eyes. The visual acuity in both eyes was 6/60 which did not improve with application of pinhole. Pars plana vitrectomy was done and sealed the macular hole in the left eye. The visual acuity remained the same in both eyes despite surgical intervention.

Toxoplasma retinochoroiditis is an entity of variable incidence according to the country and it is prevalent in Colombia and Latin America. The purpose of this report is to present two cases of toxoplasma retinochoroiditis with unusual associations with other retinal diseases. The first case corresponds to a young immunocompetent patient who developed toxoplasma retinochoroiditis in one eye and was treated. Six years later, he presented a similar picture in the contralateral eye and the same diagnostic was done. But the evolution was torpid and finally an herpetic acute retinal necrosis was confirmed. The second case corresponds to a healthy young patient, who developed toxoplasma retinochoroiditis and at the time of diagnosis he had exudative lesions in the same eye, that difficulted the diagnosis and were due to adult Coats´ disease.

Purpose: This study aimed to assess five intraocular lens (IOL) formula refractive outcomes in eyes with extreme axial length (AL) in the day-to-day practice of a secondary care center. Design: This is a retrospective consecutive case series. Methods: From all uneventful phacoemulsification cataract surgeries performed during 2018 (n = 1528), eyes with AL ≤22 mm and ≥25 mm were included and, after applying exclusion criteria, were validated (n = 114). Five IOL power formula predictions were compared to registered postsurgical refractions using IOL Master 500^©. Two subgroups were created: eyes with AL ≤22 mm (n = 52) and AL ≥25 mm (n = 62). The formula performance in each subgroup was assessed by values of mean error, mean absolute error (MAE), median absolute error, standard deviation, and frequencies of eyes within lesser values of prediction error (PE). Results: The formulae presented different PE values in both subgroups. In AL ≤22 mm subgroup, the MAE was 0.622 (±0.120) for Barrett II, 0.684 (±0.153) for Haigis, 0.625 (±0.131) for Hoffer Q, 0.593 (±0.130) for Holladay I, and 0.593 (±0.119) for SRK/T, without statistical significance (P > 0.05). In AL ≥25 mm subgroup, the MAE was 0.409 (±0.110) for Barrett II, 0.739 (±0.159) for Haigis, 1.143 (±0.224) for Hoffer Q, 1.058 (±0.212) for Holladay I, and 0.928 (±0.190) for SRK/T, with statistical significance compared to Barrett II and Haigis (P < 0.001). In this subgroup, the application of Wang–Koch AL adjustment seemed an advantage in Hoffer Q and Holladay I, whereas a disadvantage in Haigis and SRK/T. Conclusions: Despite performing better than any other formulae, the 4^th generation formulae performed worse than initially expected. Formula constants might explain this difference, and different IOL models can be used. However, these limitations are faced in day-to-day practice. Thus, these results hold their value as real-life refractive outcomes in eyes with extreme AL.

Purpose: The aim of the study is to evaluate the structure-function relationship measured with NIDEK RS-3000 advance spectral-domain optical coherence tomography and standard automated perimetry (SAP) in a Hispanic population. Methods: Eighty-three eyes with open-angle glaucoma (mean age: 63.4 years, 24% male and 76% female) and 163 eyes with glaucoma suspects (mean age: 51.6 years, 38% male and 62% female) were included in a cross-sectional study. The connection between retinal nerve fiber layer (RNFL), optic disc and ganglion cell complex (GCC) reduction, and visual field losses were evaluated, and Pearson's correlation coefficients (R) was calculated. Results: A significant but mild correlation (R = 0.24; P < 0.002) was seen between functional and structural parameters in glaucoma suspects. After the classification of the patients by the Hodapp–Parrish–Anderson glaucoma grading scale, at mild glaucoma, it was established a significant correlation between SAP with temporal RNFL (R = 0314; P < 0.003) and optic disc (R = 0.36; P < 0.012). In relation to moderate glaucoma, it was found a higher correlation between temporal thinning of RNFL (R = 0.734; P < 0.005) and inferior GCC (R = 0.506; P < 0.023). At advanced glaucoma, there was a stronger correlation (R = 0.711;xz P < 0.014) between superior RNFL and optic disc with corresponding topographic SAP locations. Conclusions: There were significant correlations between RNFL, optic disc and GCC loss, and deficits on SAP that increase with the glaucoma severity. This damage could be predictive of visual field loss, the defects went from generalized to localized, and the change rates were directly related to the stage of the disease.

Context: Extracellular vesicles (EVs) are related to the dissemination of the pathogen and to the regulation of the host immune system in infectious diseases. However, the role of EVs in Ocular toxoplasmosis remains unclear. Aims: The goal of this study was to identify and characterize the concentration and size of EVs in the aqueous humor (AH) and plasma of patients with ocular toxoplasmosis (OT) compared to other types of uveitis (OTU) and cataract. Settings and Design: AH and plasma were collected from six patients with active OT, six patients with OTU, and six patients with cataract. All patients were also assessed clinically. Subjects and Methods: EVs were isolated using the membrane affinity column method. Nanoparticle Tracking Analysis (NTA) was performed to determine the size and concentration of EVs. Statistical Analysis Used: The ANOVA test was used to determine statistical difference. P < 0.05 was considered statistically significant. Results: EV was present in the AH of different types of uveitis as well as in patients with cataract. The concentration of EV in AH was significantly lower in OT and OTU compared to cataract (P = 0.03). However, in the plasma, all groups presented a similar concentration of EV. The size of EV was the same in the AH and plasma among the three groups. Conclusion: This initial study successfully identified and characterized EVs in the AH and plasma from patients with OT as well as OTU and cataract. Further studies are necessary to better understand the role of EVs in different ocular pathologies.