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

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

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

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

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

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

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

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

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