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Original Article: High risk of intraocular pressure rise with difluprednate post collagen cross-linking for keratoconus |
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Sofia Ramos Bartolomei, Lilia Rivera Román Pan Am J Ophthalmol 2021, 3:14 (7 April 2021) DOI:10.4103/pajo.pajo_83_21
Purpose: To report intraocular pressure (IOP) after use of difluprednate ophthalmic solution 0.05% (Durezol®; Novartis AG, Basilea, Switzerland) post corneal cross-linking (CXL) versus prednisolone (Pred-Forte®; Allergan Inc., Irvine, CA, USA).
Methods: A retrospective single-center case series evaluation of 34 keratoconus patients ages 16-“41 (36 eyes) who underwent CXL with Avedro's KXL System® (Avedro Inc; Waltham, MA) between August 2016 and August 2017. Post-CXL, six eyes were given difluprednate and 30 were given prednisolone. IOP was recorded using Reichert model 30 pneumatonometer. Those that exhibited increased IOP at 3 days were given anti-glaucoma medications and changed to fluorometholone or loteprednol.
Results: IOP's 3 days' postoperative (24.167 ± 5.23) in the difluprednate group were significantly higher than preprocedure (16.5 ± 2.258). In the prednisolone group, 3 days postprocedure the mean IOP (14.2 ± 3.199) was not significantly higher than preoperatory IOP mean (16.8 ± 4.232). The difference between IOP 3 days' postprocedure and before was 7.667 ± 4.546 for the difluprednate group and 2.567 ± 2.648 for the prednisolone group. These were compared using an unpaired t-test (t value = 3.750 ± 1.297) with P = 0.0007.
Discussion: This study shows statistically significant difference in postoperative and preoperative IOP values after the use of difluprednate or prednisolone in young patients postCXL. Measuring the pachymetry on follow-up examinations could help see if changes in corneal thickness affect measured IOP. A controlled prospective double-blind study could confirm a greater increase in IOP following difluprednate versus prednisolone use, but due to the high risk, we do not recommend this study.
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Review Article: Clinical approach to a case of anterior uveitis - A non-systematic review |
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Barkha Mehta, Mithun Thulasidas Pan Am J Ophthalmol 2021, 3:13 (7 April 2021) DOI:10.4103/pajo.pajo_81_21
Anterior uveitis is the most common form of uveitis, with varying incidences reported in the literature. Anterior uveitis can be benign at the time of presentation; however, it often can lead to severe morbidity if not managed appropriately. The present article assists ophthalmologists in correctly diagnosing anterior uveitis and improving the quality of patient care. It is essential to go into the detailed history of the patient complaints. A thorough and detailed extraocular and ocular examination should be done. Ophthalmologists need to work up each case in a systematic manner.
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Case Report: Unilateral Purtscher's retinopathy |
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Daniel Fuentes-Perez, Marlon Garcia-Roa, Ariadna Silva-Lepe, Miguel Vazquez-Membrillo Pan Am J Ophthalmol 2021, 3:12 (7 April 2021) DOI:10.4103/pajo.pajo_79_21
We report herein a case of a 17-year-old male who presented status postmotor vehicle accident resulting in severe polytrauma and reduced visual acuity in his right eye (OD). Best-corrected visual acuity (BCVA) was 20/400 OD and 20/20 in his left eye (OS). Slit-lamp examination confirmed normal anterior segment anatomy in both eyes (OU). Indirect ophthalmoscopy and subsequent fluorescein angiography confirmed the presence of multiple cotton-wool spots, intraretinal hemorrhages, a well-circumscribed area of macular whitening, and vascular tortuosity throughout the posterior pole and peripapillary region, all suggestive of an arterio-occlusive event OD, with a normal fundus examination OS. Imaging of the macula with optical coherence tomography demonstrated hyperreflectivity of the inner retina, along with subfoveal irregularities of the outer retinal segments OD. Systemic steroid therapy was initiated, and after 1 month, BCVA improved to 20/70 OD.
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Short Communication: Ocular symptoms and clinical profile associated with COVID-19 |
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Tarun Kumar Suvvari, Venkata Dinesh Kumar Kandula Pan Am J Ophthalmol 2021, 3:11 (7 April 2021) DOI:10.4103/pajo.pajo_75_21
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a highly contagious pathogen, led to the coronavirus disease 2019 (COVID-19) pandemic. Ocular secretions can be one of the possible causes of SARS-CoV-2 transmission, and it should not be ignored. In the group of severe COVID-19 complications, ocular manifestations are underreported, and elucidation of ocular signs among COVID-19 patients is necessary. According to many research studies, conjunctivitis and sore eyes were the most reported ocular symptoms. Many studies have limitations such as low sample size or lack of proper findings, and much more studies need to be performed for a better inference.
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Original Article: Chromosomal microarray in isolated congenital and developmental cataract |
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Thales A. C De Guimarães, Jenina E Capasso, Nicholas R Bello, Nutsuchar Wangtiraumnuay, Michelle D Lingao, Wadakarn Wuthisiri, Yu-Hung Lai, Erica S Johnson, Mario Zanolli, Vikas Khetan, Renu Bajaj, Zi-Xuan Wang, Stephen C Peiper, Alex V Levin Pan Am J Ophthalmol 2021, 3:10 (7 April 2021) DOI:10.4103/pajo.pajo_63_20
Introduction: The etiologies of congenital and developmental cataracts are diverse. Most are not syndromic and have no identifiable cause, thus creating a diagnostic dilemma. We investigated the utility of chromosomal microarray in identifying the etiology of isolated childhood cataracts.
Methods: Patients with congenital or developmental cataracts without other associated abnormalities received a single-nucleotide polymorphism (SNP) microarray. copy number variations (CNV) and regions of homozygosity (ROH) were compared with previous literature reports and analyzed for candidate genes to assess pathogenicity.
Results: We enrolled 37 patients. The mean age of the patient population was 10.98 years old. Nineteen patients (51.4%) had bilateral cataract. Positive family history was found in 11 patients (29.7%). Eighteen patients (48.7%) had a variant on microarray: 10 (27%) with CNV, 5 (13.5%) with ROH, and 3 patients (8.1%) with both CNV and homozygosity. In five patients (13.5%), we found a potentially causative cataract gene within an ROH.
Discussion: There is a high rate of notable findings among the CNV and ROH detected. Three patients were homozygous in a region known to have a cataract gene suggesting a possible autosomal recessive disease. In those with CNV, segregation would help to affirm the pathogenicity of these regions and may lead to the identification of new genes.
Conclusion: SNP microarray had a surprisingly high rate of notable findings in patients with isolated cataract and may reveal the opportunities for genetic counseling, lead to discovering new cataract genes and identify additional affected genes that could lead to other clinical abnormalities.
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