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Letter to the Editor: More than one option |
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Anubhav Chauhan, Deepak Kumar Sharma Pan Am J Ophthalmol 2022, 4:33 (23 June 2022) DOI:10.4103/pajo.pajo_26_22 |
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Case Report: Choroidal rupture and macular hole secondary to blunt trauma |
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Catherine Pancini Rezende, Felipe Belucio de Souza, Beatriz Crotti Peixoto, Andre Luis Ayres da Fonseca, Marcelo Vicente de Andrade Sobrinho Pan Am J Ophthalmol 2022, 4:32 (23 June 2022) DOI:10.4103/pajo.pajo_22_22
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.
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Case Report: Retrobulbar hemorrhage: A complication to remember |
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Ana Maria Guzman, Maria Alejandra Martinez-Ceballos, Jaime De La Hoz Pan Am J Ophthalmol 2022, 4:31 (23 June 2022) DOI:10.4103/pajo.pajo_21_22
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.
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Case Report: Iris claw to the rescue - A case series |
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Soumya Ramani, Rachana Kotian Pan Am J Ophthalmol 2022, 4:30 (23 June 2022) DOI:10.4103/pajo.pajo_20_22
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.
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Case Report: Ocular cryptococcosis in a HIV-positive patient |
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Beatriz Crotti Peixoto, Bianca Prado Patrus, Felipe Belucio de Souza, Catherine Pancini Rezende, Augusto Terra Baccega, Marcelo Vicente de Andrade Sobrinho Pan Am J Ophthalmol 2022, 4:29 (23 June 2022) DOI:10.4103/pajo.pajo_4_22
We report a rare case of ocular cryptococcosis that presents as chorioretinitis in a patient with acquired immunodeficiency syndrome.
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Case Report: Corneal perforation in a patient with COVID-19 pneumonia under helmet continuous positive airway pressure ventilation treatment |
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Maria Joao Matias, Miguel Ruao, Joao Costa, Joao Chibante-Pedro, Ines Almeida Pan Am J Ophthalmol 2022, 4:28 (23 June 2022) DOI:10.4103/pajo.pajo_1_22
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.
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Original Article: An observational study of exotropia with the application of the Classification of Eye Movement Abnormalities and Strabismus |
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Snehal R Thakre, Vishwesh Shirish Malgi, Pradnya A Deshmukh Pan Am J Ophthalmol 2022, 4:27 (23 June 2022) DOI:10.4103/pajo.pajo_17_22
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 3rd 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.
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Case Report: Unilateral acute anterior sclero-uveitis preceding Corona virus disease (COVID-19) |
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Srinivasan Sanjay, Ankush Kawali, Sameeksha Agrawal, Padmamalini Mahendradas Pan Am J Ophthalmol 2022, 4:26 (19 May 2022) DOI:10.4103/pajo.pajo_14_22
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.
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Case Report: Late presentation of isolated spherophakia in an elderly woman with bilateral angle closure and cataract managed by lens extraction and retropupillary iris-claw lens implantation |
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Ajita Sasidharan, Mithun Thulasidas Pan Am J Ophthalmol 2022, 4:25 (19 May 2022) DOI:10.4103/pajo.pajo_6_22
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.
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Original Article: A comparative evaluation of sub-Tenon's anesthesia versus peribulbar anesthesia in manual small-incision cataract surgery |
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P Ramya Deepthi, Chavan Kumar Amruth, Biradavolu Asritha, Vuppaluru Gowtami Pan Am J Ophthalmol 2022, 4:24 (19 May 2022) DOI:10.4103/pajo.pajo_13_22
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.
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Original Article: Vitreoretinal practice during the COVID-19 era in a tertiary care hospital in Central India |
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Rajesh Subhash Joshi, Vandana Akshay Iyer Pan Am J Ophthalmol 2022, 4:23 (19 May 2022) DOI:10.4103/pajo.pajo_133_21
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.
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Original Article: Episcleral brachytherapy in Portugal for the treatment of uveal melanoma |
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João Chaves, Miguel Raimundo, Júlia Fernandes, João Casalta-Lopes, Paulo César Simões, Joaquim Murta, Cristina Fonseca Pan Am J Ophthalmol 2022, 4:22 (19 May 2022) DOI:10.4103/pajo.pajo_135_21
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.
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Original Article: Trochlear apparatus calcification and its association with diabetes: A cross-sectional study among patients undergoing computed tomography scan involving orbit |
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L Yashas Ullas, N Rachegowda, RB Revanth, G Rahul Deep, Sahana N Gowda Pan Am J Ophthalmol 2022, 4:21 (19 May 2022) DOI:10.4103/pajo.pajo_10_22
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.
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Review Article: Case report and literature review of epithelial downgrowth post-penetrating keratoplasty |
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Samyuktha Melachuri, Shane Seipel, Jennifer Li, James D Brandt, Mark J Mannis Pan Am J Ophthalmol 2022, 4:20 (19 May 2022) DOI:10.4103/pajo.pajo_9_22
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.
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Original Article: Implementation of teaching strategies and innovation to comply with the training competencies in an ophthalmology residency program during the coronavirus disease-19 pandemic |
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Angel Eduardo Gonzalez-Garcia, Yolanda Macias-Rodriguez, Raul E Ruiz-Lozano, Alejandro Rodriguez-Garcia Pan Am J Ophthalmol 2022, 4:19 (20 April 2022) DOI:10.4103/pajo.pajo_124_21
Purpose: The coronavirus disease (COVID)-19 pandemic put medical residency programs in a predicament, impacting clinical attention and surgical practice. This study aims to describe the adjustments applied in an ophthalmology residency program to overcome the COVID-19 pandemic restrictions.
Materials and Methods: An observational, comparative, and descriptive study was performed in an ophthalmology residency program to analyze the adaptations and innovations implemented to overcome the medical attention and training restrictions enforced by the sanitary authorities due to the COVID-19 pandemic in the year 2020. The residents' record folders were analyzed yearly for academic, research, clinical, and surgical activities from 2018 to 2020. An online survey was applied to residents for congress attendance, research publications, time spent on classes, lectures, clinical cases, journal club, and surgical videos sessions during the pandemic.
Results: Compared to years 2018 and 2019, during 2020, there was a significant increase in the hours destined per week to academic activities (6.04 vs. 16.42 h, P < 0.001); the monthly hours of journal club sessions (0.5 vs. 3.41 h, P < 0.001); and the number of published articles involving residents (0.4 vs. 2.52, P < 0.001). On the contrary, the hours of outpatient consultation (8 h/day vs. 4 h/day) and the number of cataract surgeries performed per resident decreased (48 vs. 15, P < 0.001) from 2019 to 2020.
Conclusions: Prompt reaction and innovation were required to overcome the educational and training barriers imposed by the COVID-19 pandemic. While remote academic activities increased significantly, online patient consultation and surgical simulation were necessary to avoid hindering patient's attention and surgical training.
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Original Article: Use of amniotic membrane ameliorating postoperative discomfort in pterygium surgery |
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Luis F Mejia, Juan C Gil Pan Am J Ophthalmol 2022, 4:18 (20 April 2022) DOI:10.4103/pajo.pajo_5_22
Purpose: To report the results of using human amniotic membrane (AM) as a bandage at the end of pterygium surgery to diminish its uncomfortable postoperative symptoms.
Materials and Methods: Observational, descriptive retrospective study in which patients with bilateral primary nasal pterygia were operated on with a conjunctival-limbal autograft with conventional suturing, one eye receiving an AM bandage at the end of surgery and the other not.
Results: There were 20 eyes of 10 patients, five men, and five women, with a mean age of 28.7 ± 6.4 years; general postoperative symptoms (pain, burning sensation, and tearing) and foreign body sensation were statistically lower in the AM group at the 4th, 8th, and 12th postoperative day (P < 0.05).
Conclusions: AM as a bandage at the end of pterygium surgery reduces the uncomfortable postoperative symptoms typical of such surgery.
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Review Article: Myopia is progressing faster than its management options |
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Ali Nouraeinejad Pan Am J Ophthalmol 2022, 4:17 (25 March 2022) DOI:10.4103/pajo.pajo_119_21
Myopia, as the most common source of distance vision impairment in the world, is a serious global public health and socioeconomic crisis. Although more than half of the world population will be myopic by 2050, none of the myopia control strategies has been demonstrated to completely stop the development or progression of myopia. This is due to the fact that myopia is progressing faster than its management options. It should also be emphasized that none of the current myopia control strategies is practically in use for some reason except for research purposes. It is of critical importance to realize that without any effectual controls or therapeutic interventions, myopia crisis enlarges further.
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Original Article: Bacterial profile and antimicrobial resistance in a Tertiary Hospital in Mexico |
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Francisco Beltran, Kristian A Vazquez Romo, Jose Arturo Oyervides Alvarado, Laura Alejandra Gonzalez Dibildox, Nallely Ramos Betancourt, Manuel Garza León, Everardo Hernandez Quintela Pan Am J Ophthalmol 2022, 4:16 (23 March 2022) DOI:10.4103/pajo.pajo_132_21
Objective: The objective of this study was to report the characteristics and the bacterial microbiological frequency of the etiological agents and the antibiotic sensitivity of the isolated pathogens in infectious keratitis in Mexico between 2012 and 2016.
Methods: This was a retrospective, cross-sectional, and observational study; medical records of all patients who presented in the cornea department in Mexico with infectious keratitis from 2012 to 2016 were reviewed. Demographic data, Gram stain, and microorganisms obtained in the culture and antibiotic sensitivities were evaluated by disc diffusion test.
Results: In the studied period, a total of 639 (40.67%) cases that had a positive culture were included; 54.5% were male with an average age of 48.50 ± 20.43. Gram-positive agents were the most frequent with 80.66% of cases. The most frequent causative agent was Staphylococcus epidermidis (36.61%). The most frequent Gram-negative agent was Pseudomonas aeruginosa (7.55%). The antibiotic with the highest sensitivity was netilmicin (90.3%), followed by moxifloxacin (82.3%) and gatifloxacin (81.3%). Among fortified antibiotics, ceftazidime had a sensitivity of 78% while vancomycin 43.8% (for Gram positive).
Conclusion: Bacteria are the most common cause of infectious keratitis, Staphylococcus and Pseudomonas as the most common isolates. There was low resistance to netilmicin and fourth-generation fluoroquinolones for these isolates.
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Case Report: Use of the dexamethasone implant as an adjunct in the treatment of Coats disease in a pediatric patient |
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Salcedo Hugo Ricardo, M Vasquez Fitha, Lalaleo Elvia Mariana Pan Am J Ophthalmol 2022, 4:15 (23 March 2022) DOI:10.4103/pajo.pajo_125_21
To report the use of intravitreal dexamethasone implant and its short-term efficacy in a pediatric patient with Coats' disease. A 7-year-old patient was referred to the clinic because of decreased visual acuity in the right eye of 10-month duration. Best-corrected visual acuity was 20/400. Funduscopic examination showed evidence of Stage 2B Coats' disease. The patient underwent treatment with laser photocoagulation, intravitreal injection of bevacizumab, and intravitreal injection of dexamethasone implant. During the 10-month follow-up, there was no evidence of side effects. Anatomical resolution was evident on funduscopic examination and macular optical coherence tomography, with best-corrected visual acuity being 20/60. Intravitreal dexamethasone implant was effective during the 10-month follow-up; providing improvement in visual acuity without any side effects.
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Original Article: Screening strategy in ocular diabetes with automatic detection system in the Chilean public health system |
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Fernando Barría von-Bischhosffshausen, G Francisco Andrighetti, G Nicole Rivera, F Vezna Sabando Pan Am J Ophthalmol 2022, 4:14 (23 March 2022) DOI:10.4103/pajo.pajo_117_21
Summary: Diabetic retinopathy (DR) is the leading cause of blindness among working-age persons in high-income countries. A public system strategy was developed to improve screening, using telemedicine, automatic detection using artificial intelligence (A/I) and medical reporting. In the current work, we evaluated program efficiency.
Material: We conducted a cross-sectional study using information from an institutional database of retinographies submitted to the A/I platform in 2019. With a positive test, a medical report was made using the international scale.
Results: In 2019, 220,994 retinographies were reported, corresponding to 24.0% of diabetic patients. Around half (53.0%) of cases were discarded by A/I, being different in each regional health service. The medical analysis discarded diabetic retinopathy in 30.2% of exams, 11.5% had diabetic retinopathy, including 2.3% with risk of blindness, while 3.7% could not be evaluated.
Discussion: The use of A/I allowed optimizing the medical resources, discarded 53% of cases, which helped in the screening of diabetic retinopathy. Coverage is still insufficient, and detection of macular edema must be improved.
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Original Article: A novel histopathological classification of chalazion: A series of 540 cases  |
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Hiroaki Ito, Georges Nassrallah, Sabrina Bergeron, Bryan Arthurs, Julia V Burnier, Miguel N Burnier Pan Am J Ophthalmol 2022, 4:13 (23 March 2022) DOI:10.4103/pajo.pajo_112_21
Introduction: A chalazion is a common localized lipogranulomatous inflammation of the eyelid. Histopathological diagnosis of chalazia is essential to rule out malignancy in particular sebaceous carcinoma. Our aim is to understand and classify the histopathological findings of chalazia and to determine any association with a patient's demographics.
Materials and Methods: H and E sections were reviewed and classified into four categories: (1) lipogranulomas only, (2) lipogranulomas with multinucleated giant cells, (3) lipogranulomas with abscess, and (4) fibrosis without lipogranulomas or granulomatous inflammation. Patients' sex, age, and location of the lesion were analyzed.
Results: Five hundred and forty cases included men (54.6%) and women (45.4%) with the mean age of 45.3 (13–89; standard deviation, 16.8). Five hundred and eight had information regarding location: left lower eyelid, 21.1%; right lower eyelid, 19.5%; left upper eyelid, 30.5%; and right upper eyelid, 28.9%. Category 1 accounted for 44.6%; category 2, 41.5%; category 3, 7.0%; and category 4, 6.9%. There was no significant correlation between classification and sex (P = 0.210) or age group (0–50 and > 50) (P = 0.369) nor between presence of giant cells and/or abscess and location (P = 0.826). Mean ages of category 1 (47.0) and 2 (43.1) were significantly different (P = 0.011).
Conclusion: Four histopathological subtypes were equally distributed across sexes and eyelid locations. Individuals in category 1 are older than category 2. Favoring a systematic way to analyze the histopathology of chalazia may result in fewer missed diagnoses of malignancy and other inflammatory or infectious diseases.
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Original Article: Rate and risk factors for posterior capsular rent in small incision cataract surgery in a teaching hospital |
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Thanuja G Pradeep, Devappa Namrata, Anju Mary Thomas Pan Am J Ophthalmol 2022, 4:12 (23 March 2022) DOI:10.4103/pajo.pajo_109_21
Purpose: The purpose was to study the proportion and risk factors for posterior capsular rent (PCR) in small incision cataract surgery in a teaching hospital.
Methods: We conducted a retrospective observational study of all cases with PCR in small incision cataract surgery performed between November 2015 and May 2018. The medical records were analyzed and data were collected.
Results: There were a total of 63 cases of PCR out of 4206 cases who underwent small incision cataract surgery with a 1.68% PCR rate. The mean age was 65.5 years and the male-to-female ratio was 2.15:1. There was no association between nuclear sclerosis, pupil dilatation, and pseudoexfoliation. Resident operated surgeries had a PCR rate of 1.96 compared to faculty operated surgeries which was 1.46. Three faculty surgeons accounted for 54.3% of the cases while the remaining ten surgeons accounted for 45.7% of the cases. Postoperative day 1 vision was low, with only 19% achieving >6/18 vision, and 54% of the individuals needed more than one topical drug and 61.5% were started on oral steroids.
Conclusion: Surgeon- and patient-related factors are equally important in avoiding posterior capsule rent in cataract surgeries. Patient-related factors should be carefully assessed preoperatively on slit-lamp biomicroscope, so that surgeons are prepared for all the complications and visual morbidity limited. Surgeon factors also need to be looked into and efforts have to be made to limit them and thus ensure the right to vision to each patient.
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Original Article: Safety and efficacy of manual small incision cataract surgery and phacoemulsification: a retrospective, comparative study in a low-to-middle-income country |
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Mario Renato Papa-Vettorazzi, José Benjamin Cruz-Rodríguez, Gladys Lucia Silva-Linares, Nuno Moura-Coelho, Nicolás Yee-Melgar Pan Am J Ophthalmol 2022, 4:11 (23 March 2022) DOI:10.4103/pajo.pajo_115_21
Purpose: To compare the efficacy and safety of manual small incision cataract surgery (mSICS) versus phacoemulsification in a referral center from a low-to-middle-income country.
Subjects and Methods: A retrospective cohort of 177 eyes with visually significant cataract and ≤1.0 diopter (D) of keratometric astigmatism was intervened during 2017 by four surgeons either by mSICS or by phacoemulsification. Last follow-up was at 4–6 weeks. Outcome measures included postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive cylinder, spherical equivalent (SE), complications, and re-interventions.
Results: The mSICS group included 107 eyes; the phacoemulsification group included 70 eyes. UDVA was comparable between both groups; 89.6% in the mSICS group and 95.7% in the phacoemulsification group achieved a UDVA ≥6/18 (20/60) (P = 0.06). CDVA was comparable between both groups; 100% in the mSICS cohort and 98.6% in the phacoemulsification cohort had a CDVA ≥6/18 (20/60) (P = 0.26). Although the absolute difference in postoperative refractive astigmatism between both groups was small, it was statistically significant in favor of the phacoemulsification group (P = 0.02). Postoperative refractive SE was also comparable between both cohorts (P = 0.64). One intraoperative complication was found in the phacoemulsification group (1.4%), with no complications in the mSICS group. However, there were six reoperations in the mSICS cohort (5.6%) and no reoperations in the phacoemulsification one.
Conclusions: Both mSICS and phacoemulsification achieved excellent visual outcomes with low complication rates. Phacoemulsification gives better UDVA and lower postoperative refractive astigmatism in a larger proportion of patients at 4–6 weeks.
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Case Report: CyberKnife robotic-assisted stereotactic radiosurgery for iridociliary melanoma |
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Gustavo Ortiz-Morales, Cinthya Parra-Bernal, Irving Dominguez-Varela, Sara Gonzalez-Godinez, Jorge Aguilera-Partida, David Ancona-Lezama Pan Am J Ophthalmol 2022, 4:10 (9 February 2022) DOI:10.4103/pajo.pajo_131_21
Iridociliary melanoma represents a rare and aggressive variant of intraocular melanoma. We report the case of a 30-year-old male with iridociliary melanoma that started as a uveitis masquerade syndrome. Noninvasive, stereotactic radiosurgery with CyberKnife® at a dose of 27 Gy to the 90% isodose line was promptly performed. Six months after treatment, no postoperative complications were observed. The patient achieved local tumor control, maintained a 20/20 visual acuity, and no signs of systemic metastasis were observed. The versatility and outpatient nature of CyberKnife® make it an option to consider for the multidisciplinary management of these patients.
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Original Article: Flower petal chop: Technique for nuclear cataract phacoemulsification |
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Rajesh Subhash Joshi Pan Am J Ophthalmol 2022, 4:9 (9 February 2022) DOI:10.4103/pajo.pajo_130_21
Objective: To describe a phacoemulsification technique to face chalenging situations such as hard and leathery nucleus.
Methods: The present technique was successfully performed in 52 eyes of 48 patients, over a period of 3 months.
Results: None of the patients had zonular dehiscence or posterior capsular rupture. In 40 eyes, the cornea was clear on the 1st postoperative day, while in 12 eyes, the cornea cleared on the 4th postoperative day. Visual acuity improved to 20/20 (corrected distance visual acuity) at the end of the 3-week follow-up.
Conclusion: The flower petal chop technique is an effective and safe technique for phacoemulsification of hard and leathery cataracts.
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Letter to the Editor: How to make a differential diagnosis between choroideremia and retinitis pigmentosa  |
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Ali Nouraeinejad Pan Am J Ophthalmol 2022, 4:8 (9 February 2022) DOI:10.4103/pajo.pajo_120_21 |
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Case Report: Paraneoplastic optic neuropathy with simultaneous retinal and choroidal metastasis in metastatic lung carcinoma: A rare entity |
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Cheau Wei Chin, Kiet Phang Ling, Francesca Martina Vendargon Pan Am J Ophthalmol 2022, 4:7 (9 February 2022) DOI:10.4103/pajo.pajo_97_21
Paraneoplastic optic neuropathy (PON) is a rare phenomenon that is associated with lung carcinoma. In addition, retinal metastasis is extremely rare, accounting for <1% of intraocular metastasis. We hereby report a rare case of synchronous metastases from lung carcinoma to the choroid of the right eye and the retina of the left eye complicated with presumed PON. The presence of intraocular mass and optic disc swelling should prompt investigations for systemic malignancies.
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Letter To Editor: Reply to comments on bilateral retinal hemorrhages and macular edema in a patient with dengue fever associated with cerebral hemorrhage |
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Rajesh Subhash Joshi, Preeti Dashrath Wadekar Pan Am J Ophthalmol 2022, 4:6 (9 February 2022) DOI:10.4103/pajo.pajo_3_22 |
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Letter To Editor: Dengue associated retinal hemorrhages and macular edema |
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Srinivasan Sanjay, Ankush Kawali, Padmamalini Mahendradas Pan Am J Ophthalmol 2022, 4:5 (9 February 2022) DOI:10.4103/pajo.pajo_122_21 |
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Letter to Editor: COP26 and health: Some progress, but too slow and not enough |
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Laurie Laybourn-Langton, Richard Smith Pan Am J Ophthalmol 2022, 4:4 (13 January 2022) DOI:10.4103/pajo.pajo_126_21 |
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Case Report: Eyelid dermoid cyst: Case report of a rare manifestation  |
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Eshwar Rajesh, R Charumathi Pan Am J Ophthalmol 2022, 4:3 (13 January 2022) DOI:10.4103/pajo.pajo_118_21
Dermoid cysts are epidermis-like cysts with dermal adnexal structures such as sebaceous glands, hair follicles, or sweat glands in the cyst wall. They contain mature or immature germ cells of pluripotent origin. The usual sites of occurrence in the periorbital region include the lateral angle of the orbit, medial angle, limbal, and deep orbital region. Here, we present a case of 16-year-old female who came to the hospital with complaints of swelling in the upper eyelid and intermittent pain. After an excisional biopsy of the mass was done, the diagnosis of tarsal dermoid cyst was confirmed. Due to the paucity of cases in literature, reporting this case may help shed light on the importance of including dermoid cyst in the differential diagnosis of a tarsus-based eyelid mass.
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Original Article: Retrospective analysis of visual acuity and final refraction after phacoemulsification surgery with intra- or postoperative complications  |
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Augusto Terra Baccega, Bianca Prado Patrus, Gustavo Lustosa Neves, Beatriz Aguiar Pedrosa Casagrande, Marcelo Vicente De Andrade Sobrinho Pan Am J Ophthalmol 2022, 4:2 (13 January 2022) DOI:10.4103/pajo.pajo_121_21
Objective: The objective of this study was to assess the incidence of complications intra- and postoperative (until the 30th day) of phacoemulsification surgery performed by residents of the third year, and its implications on final refraction and best-corrected visual acuity (VA), compared to those who did not exhibit any complication.
Methods: This was a retrospective analysis of 300 medical records of patients who had their surgeries performed from January 2019 to February 2020 by the same three third-year residents. Fifty medical records were excluded. Initial VA logarithm of the minimum resolution angle and final VA with the best correction were analyzed, comparing whether there was a correlation with the presence of complications.
Results: Of the 250 medical records analyzed, 29 (11.6%) presented complications during the intraoperative period, been posterior capsule rupture the mean one. The mean VA of patients without complications was 0.13 ± 0.17 (0.00–1.00) compared to 0.29 ± 0.28 (0.00–1.00) for those who had complications. The spherical equivalent of those without complications was −0.87 ± 0.98 (−4.38–2.00) compared to −1.19 ± 1.14 (−3.75–0.50) of the that had.
Conclusion: As shown in this study, the percentage of complications is compatible with those found in the literature, also exhibits that surgeries with complications do imply in worst VA. However, when compared among themselves, before and after surgery, there was a significant improvement in the VA even in patients with complications.
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Case Report: Cytomegalovirus retinitis in Crohn's disease treated with anti-tumor necrosis factor-alpha antibody  |
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Cristobal Andres Nazar, José Antonio San Martín, Rodolfo I Garretón, Aldo Andres Muñoz Pan Am J Ophthalmol 2022, 4:1 (13 January 2022) DOI:10.4103/pajo.pajo_116_21
Cytomegalovirus (CMV) is a double-stranded DNA virus. It is an opportunistic infection that usually affects individuals with AIDS or with profound immunosuppression. CMV retinitis is the most frequent ocular manifestation. Infrequently, this pathology has been observed in patients undergoing immunosuppressive treatment due to autoimmune diseases. This article presents a case of Crohn's disease with systemic and ocular involvement by CMV after starting treatment with infliximab (anti-tumor necrosis factor-alpha antibody).
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