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.