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Visual symptoms after a cardiac ablation procedure: A report of three cases
Catarina M Monteiro, Mafalda S B. Mota, Mário R R. Ramalho, Isabel M C. Prieto
2021, 3:23 (13 July 2021)
The current study reports three cases of both adult and pediatric patients with a history of self-limited episodes of visual symptoms following ablative procedures for cardiac dysrhythmias. Neurological and ophthalmological evaluations were always unremarkable even when performed during the episodes. The visual disturbances subsided spontaneously, and none of the patients developed any kind of permanent visual damage.
  11,289 140 -
Ramsay Hunt syndrome in a young COVID-19 patient
Claudia P Alonzo-Correa, Eduardo Camacho-Martínez, Andres Bustamante-Arias, Alejandro Rodriguez-Garcia
2021, 3:33 (22 October 2021)
The severe acute respiratory syndrome caused by coronavirus-2 can present with a broad spectrum of clinical manifestations, mainly respiratory, but also with different neurologic symptoms. On the other hand, the Ramsay Hunt syndrome (RHS) is a complication of varicella-zoster virus (VZV) reactivation presenting mainly in older patients, patients under stress, infection, or an immunocompromised state. We report a case of RHS in a young Mexican female patient who tested positive for SARS-CoV-2 in whom we believe that there is a strong possibility that VZV's unusual reactivation, presenting as RHS in a young patient, might have been a consequence of the immunological alterations induced by this coronavirus.
  7,935 157 -
Eduardo Arenas, Gioconda Armas, Alfredo Ramirez
2019, 1:9 (26 September 2019)
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.
  6,807 656 -
Pediatric ocular myasthenia gravis: Case report and literature review
Adriana Solano, Veronica Jimeno, Luisa Montoya, Natalia Espinosa
2019, 1:16 (3 December 2019)
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.
  6,181 478 -
Quality of life results after vitreolysis in patients with symptomatic vitreous floaters
Renzo Canote, Daniela Rodríguez, Luis Izquierdo, Roger Moncada, Carmen Maldonado, Alejandra Henriquez Maria
2020, 2:2 (23 January 2020)
Purpose: The purpose of the study was to evaluate the quality of life and visual results after yttrium aluminum garnet (YAG) vitreolysis in symptomatic vitreous floaters. Methods: This was a prospective case series study including patients with symptomatic floaters attending the Oftalmosalud Institute of eyes and underwent YAG laser vitreolysis. All patients completed the National Eye Institute Visual Functioning Questionnaire 25 for the quality of life assessment and the presence of floaters as well as the measure of the visual acuity reported preprocedure and after 3-month follow-up. Statistical analysis was done using score 0–100 for each question, and a sign test for paired samples was used. Results: Twenty eyes of 20 patients were evaluated. The comparisons for the questionnaire show an improvement in the general vision (P = 0.008), near vision (P = 0.001), and distance vision (P = 0.012). Furthermore, the dependency of glasses (P = 0.012), the score of mental health (P = 0.007), and the best visual acuity (P = 0.004) were improved. Patients who referred improvement in the quality of life were 75% pseudophakic patients and 25% phakic patients. The complications were high intraocular pressure and subcapsular cataract. Conclusions: Our study revealed a moderate improvement in floater symptoms and in quality of life and visual outcomes.
  4,206 472 -
Comparison of toric intraocular lens calculation using the new corneal curvature measurement methods and the haigis suite, barrett tk, barrett toric, and z calc formulas
Carlos Emiliano Rodriguez Lopez, Guadalupe Fernando Mora González, Jorge Rendón Félix, Gerardo Daniel Jáuregui García, Miguel Angel Ibañez Hernández
2020, 2:23 (19 August 2020)
Background: More than 50% of patients undergoing cataract surgery have corneal astigmatism ≥ 0.75 diopters (D). A fundamental factor for the calculation of the intraocular lens (IOL) is the power of corneal refraction, which can be calculated with different methods and incorporated into different mathematical prediction models. Little information has been written comparing new formulas that take into account posterior keratometry. Aims and Objectives: Compare the prediction of the ideal IOL with different formulas that use anterior keratometry and posterior keratometry measured by different devices. Setting: Private practice, Guadalajara, Jalisco, Mexico. Materials and Methods: A descriptive, observational and retrospective study was carried out where 50 healthy eyes with cataract and a degree of corneal astigmatism >1 D were evaluated, IOL calculation was compared using the anterior and total keratometries measured with the Zeiss IOL master 700 and the total corneal refractive power (TCRP) keratometries of the Oculus Pentacam. The results were also compared with the Haigis Suite, Barrett TK and Z Calc formulas. The IOL used for the analysis was the Zeiss AT TORBI 709M/MP. Results: It was found that the different formulas can generate different predictions in the cylinder power but no significant differences in the sphere power. Measurement of the posterior cornea did not significantly change the selection of the ideal IOL for implantation. Calculations with Haigis Suite and Z Calc are very similar. Barrett TK-Toric uses less cylindrical power than Haigis Suite and Z calc, regardless of the method chosen to measure corneal power. Conclusion: Our results contribute to clarify the current scenario where the great variety of options for the calculation of IOL generates uncertainty about which method generates better results of postoperative refraction.
  4,056 370 -
Vision loss and psychopathology
John R Mark, Andrea G Kulinich, Lorin M Scher, Mark J Mannis
2021, 3:7 (10 February 2021)
Purpose: By examining associations between vision loss and various types of psychopathology within the literature, this manuscript will provide ophthalmologists, psychiatrists, and psychologists insight into the relationships between vision and psychopathology to foster cross-professional relations. Design: Retrospective narrative literature review. Methods: A narrative literature review was conducted using PubMed, Google Scholar, and Scopus searches. Study types included reviews, case studies, survey analyses, population-based studies, and twin studies, among others. Topics explored include mental health consequences of vision loss, functional neurological disorders and deception syndromes, eye specific personality changes, Charles Bonnet syndrome, and vision disorders associated with psychosis. Results: Visual impairment correlates with depression and worsened overall quality of life and mental health. Visual health clinicians should improve competencies in basic suicide risk assessments in collaboration with primary care providers and mental health colleagues. When patients with functional neurological disorders or deception syndromes present, understanding their symptoms and motivations is crucial for proper management. Patients with myopia and keratoconus are anecdotally alleged to have unique personalities; however, research shows openness is the only trait correlated with myopia, while a proposed “keratoconus personality” is unfounded. The unique vivid hallucinations of Charles Bonnet syndrome typically do not bother patients and physician reassurance is usually enough to ease the anxious patient. Finally, Usher syndrome involves congenital deafness and progressive blindness in young children with links to psychosis and schizophrenia. Conclusions: The bidirectional psychosomatic ophthalmological landscape highlights a need to improve screening, recognition, and integrated treatment coordination between visual health providers and mental health providers.
  4,149 277 -
Multimodal imaging ocular sarcoidosis
Jaime Larrea, Luz Catherine Martinez Malo, Daniel Jaramillo-Velásquez, Carlos Mario Rangel
2019, 1:14 (6 November 2019)
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.
  3,988 380 -
Clinical approach to a case of anterior uveitis - A non-systematic review
Barkha Mehta, Mithun Thulasidas
2021, 3:13 (7 April 2021)
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.
  3,983 290 -
A floppy eyelid syndrome case report: Surgery and histopathologic features
Marcela Feltrin de Barros, Livia Garcia Biselli, Gustavo Kalache, Marcelo Vicente de Andrade Sobrinho, Laryssa Pereira Alves, Daniella De Paiva Almeida Stucchi
2020, 2:1 (23 January 2020)
We report a case of floppy eyelid syndrome (FES) treated with surgical approach at the PUC Campinas Hospital in 2019. This was a retrospective case report. A 42-year-old male patient diagnosed with FES. The patient elected for surgical repair due to severity of his symptoms. A lateral pentagonal upper eyelid resection was performed in the left eye, and eyelid tissue from the patient was examined using light microscopy and immunohistochemistry that revealed chronic conjunctival inflammation and papillary conjunctivitis. The pentagonal wedge resection is an effective treatment method that produces immediate relief of symptoms. In our case, no recurrence was observed up to 6-month follow-up.
  3,489 489 -
Granuloma annulare in a young patient: An unusual presentation
Vinicius Clementino Falcao, Elvira Barbosa Abreu, Julia Valdemarin Burnier, Miguel Noel Burnier
2019, 1:10 (7 October 2019)
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.
  3,687 275 -
Retrolental vascular membrane in a case of ciliary body medulloepithelioma: Clinicopathologic correlation
Luca Bongiovanni De Miranda Gonçalves, Joao Carlos De Miranda Gonçalves, Maria Cristina Martins, Miguel N Burnier
2019, 1:15 (6 November 2019)
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.
  3,641 319 -
Weil–Marchesani syndrome: A case report and literature review
Carlos Emiliano Rodríguez Lopez, Guadalupe Fernando Mora González, Gerardo Daniel Jáuregui García
2020, 2:10 (23 April 2020)
Weill–Marchesani syndrome is a rare connective tissue disorder, with a poorly understood etiology that has been primarily related to hereditary genetic factors, including mutations in ADAMTS10 and fibrillin-1. Clinically, it is characterized by a phenotype of short stature and brachydactyly, associated with joint stiffness and eye problems that begin to be noticed in childhood. There is little information about this disease in the Mexican population. This is a description of the case of a 17-year-old female patient with clinical feature compatible with this syndrome, as well as a brief review of the literature on this entity. The knowledge of this syndrome is important to achieve a timely diagnosis and prevent the complications associated with it.
  3,611 281 -
Poppers' maculopathy
Renzo Canote Flores, Johana Rueda Rueda
2019, 1:8 (26 September 2019)
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.
  3,605 273 -
Multidisciplinary management of neurotrophic and exposure keratopathy secondary to clivus chordoma resection: An ocular surface challenge
Nallely Morales-Mancillas, Andres Bustamante-Arias, Juan Homar Paez-Garza, Hector Marines-Sanchez, Alejandro Rodriguez-Garcia
2020, 2:7 (24 March 2020)
The purpose is to report the ocular complications observed after compound cranial nerve palsies secondary to multiple clivus chordoma resection surgeries. A 38-year-old man was referred to our clinic with diplopia and foreign-body sensation. Examination revealed a right peripheral facial paralysis with paralytic lagophthalmos leading to exposure keratopathy and a right sixth nerve palsy with esotropia. Subsequently, the patient developed a longitudinal fusiform-shaped corneal epithelial defect in the right eye. The corneal sensation was reduced due to a fifth nerve palsy leading to neurotrophic keratopathy. The combination of neurotrophic with exposure keratopathy is one of the worst scenarios for corneal integrity.
  3,614 252 -
Birdshot chorioretinopathy: Importance of early diagnosis and therapeutic individualization
Elisabet Martin Garcia, Leticia Rodríguez Vicente, José Javier Chávarri García, José Luis del Rio Mayor
2020, 2:3 (23 January 2020)
Introduction: Birdshot chorioretinopathy (BCR) is a bilateral and recurrent posterior uveitis with an uncertain natural history and visual prognosis. Currently, there is no consensus on the best treatment option and its total duration. Clinical Cases: We present a series of three clinical cases of patients with BCR diagnosed in different stages of the disease, which demonstrates the clinical spectrum of this pathology and their treatment with different immunomodulatory drugs. Conclusion: As shown in our series of cases, the early use of immunomodulatory drugs is recommended with a close monitoring and individualized treatment to achieve the best anatomical and functional results.
  3,452 413 -
Prevalence of cataract and barriers to cataract-related care in rural Ecuador
Sila Bal, Carlos Gonzalez, Sarah Marjane
2019, 1:7 (26 September 2019)
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.
  3,546 312 -
Corneal transplant epidemiology in a reference center in Bogotá, Colombia (2010-2017)
Matilde Mora, María Cristina Cortés, María Camila Plata, Daniel Suárez Acosta
2021, 3:39 (26 November 2021)
Purpose: To describe the characteristics of the donor and recipient, indications, surgical techniques, and survival results obtained from patients with corneal transplants performed at Fundación Oftalmológica Nacional (FUNDONAL) between 2010 and 2017. Methods: Descriptive, observational study. Medical records of patients who underwent corneal transplantation were reviewed. Demographic data, surgery indication, transplantation technique, graft transparency, and presence of rejection are evaluated. Statistical analysis was performed with the SPSS software version 21.0. Results: Seven hundred and twelve eyes from 690 patients who underwent corneal transplantation were analyzed. The median age of the recipient was 42 years (interquartile range 21.8 years) and 392 participants (56.8%) were men. Corneal ectasias was the first indication for transplantation. The technique performed most often was penetrating keratoplasty (PK) (89.6%), followed by deep anterior lamellar keratoplasty (5.3%), endothelial keratoplasty (3.5%), and sclerokeratoplasty (1.5%). 22.25% of the cases presented at least one rejection episode. Transparency of the graft is >80% up to 36 months from follow-up. Conclusions: In 712 eyes that underwent corneal transplantation between 2010 and 2017, the most frequent indications were corneal ectasias, pseudophakic/aphakic bullous keratopathy, and previous graft failure. Although the most common technique is PK, there is a tendency to perform more lamellar transplants over the years. Survival up to the last control was 78% with graft rejection at 22.23%, which are comparable with results reported in the scientific literature. This study constitutes the first corneal transplant registry in Colombia, with survival results and description of variables that will allow for the identification of risk factors for undesirable outcomes.
  3,620 126 1
How lethal is a pellet gun for eyes?
Suhail Rafiq, Musaib Ahmad Dar, Jan Muhammad Suhail, Arshid Ahmad Bhat, Irshad Mohideen
2020, 2:5 (27 February 2020)
Background: Etiologically ocular injuries can be classified into domestic, occupational, sports, road traffic accidents, iatrogenic, fights and assaults, and war injuries. In the 1960s and 1970s, road traffic accidents became the most common cause of serious ocular injuries. In the 1980s, sports and leisure activities became a common cause of severe eye injury. The home is now the most common location for eye injuries. However, bomb blast and battlefield ocular injuries are becoming increasingly common in different parts of the world. Recently introduced non-lethal pellet guns used by law enforcement Indian agencies in Kashmir were the most common cause of ocular injuries in the valley. Objective: The objective of this study was to evaluate ocular pellet gun injuries in patients of a conflict zone by a so called non-lethal weapon as a mass control measure. Method: The study was conducted in post graduate department of Radiodiagnosis and imaging, Government Medical College, Srinagar Jammu and Kashmir. Our study was conducted between January 2019 to 15th May 2019. A total of 30 patients with ocular pellet injuries were taken up for study. Results: The most common type of injuries encountered were corneal laceration in 66.7 % eyes, vitreous haemorrhage in 52.8% and scleral laceration in 33.3% of eyes. Indirect signs like decreased volume of anterior chamber were suggestive of corneal laceration. Retained intraocular foreign body (IOFB) was seen in 7 patients and intraorbital foreign body excluding intraocular foreign body in 3 patients. Conclusion: In conclusion a so called non-lethal pellet gun used by law enforcement agencies has the potential to cause devastating ocular injuries.
  3,443 289 -
Relationship between spectral domain optical coherence tomography and the perimetry automated in glaucoma suspect and glaucoma in hispanic population
Jeanneth Toquica, Fernando Gomez-Goyeneche, Maryudi Velandia-Plata, Diana Sarmiento-Forero, Gerardo Ardila-Duarte
2019, 1:2 (8 August 2019)
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.
  3,405 326 -
Don't let me down: New intraocular lens formula effectiveness in extreme-length eyes in day-to-day practice
Tiago Morais-Sarmento, Ricardo Figueiredo, João Garrido, Ana Luísa Rebelo, Olga Berens, Augusto Candeias
2019, 1:3 (8 August 2019)
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 4th 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.
  3,372 339 -
Giant molluscum contagiosum mimicking a lid abscess: “Appearances can be deceptive”!!
Yamini Priya, Anupama Janardhanan
2019, 1:12 (16 October 2019)
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.
  3,388 301 -
A continuous red eye: Case report about a carotid cavernous fistula
Sonia Cristina Raposo Parreira, Sandra Barros, Diogo Lopes, Joaquim Silva, Nuno Campos
2019, 1:11 (16 October 2019)
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.
  3,348 297 -
Pars plana Ahmed glaucoma valve implantation in refractory glaucoma: Surgical technique and long-term outcomes
Harsh Kumar, Avnindra Gupta, Suman Bandil, Mithun Thulasidas
2020, 2:16 (24 June 2020)
Purpose: The aim of this study was to evaluate the long-term efficacy of intraocular pressure (IOP) control and complications of pars plana Ahmed glaucoma valve (AGV) implantation in refractory glaucoma patients. Design: This was a prospective interventional study. Materials and Methods: We conducted a single-center study, involving eyes with refractory glaucoma. Study variables were IOP, the number of glaucoma medications, and corrected distance visual acuity (CDVA) evaluated preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and every 6 months till the last follow-up. Complete success was defined as absolute if IOP was between 6 and 21 mmHg in the absence of any glaucoma medication and qualified success if IOP was between 6 and 21 mmHg with medication at the last follow-up. Results: The study included 27 patients (29 eyes) with a mean age of 54.28 (standard deviation [SD]: 16.76; range: 11–73) years and a mean follow-up of 21.31 (SD: 20.38; range: 6–60) months. The mean IOP reduced from 38.14 (SD: 7.4; range: 25–50) mmHg preoperatively to 12.76 (SD: 3.92; range: 6–20) mmHg at the last follow-up (P <0.001). CDVA improved in 16 (55.2%) eyes, remained the same in 10 (34.5%) eyes, and worsened in 3 (10.3%) eyes. There was a mean reduction of antiglaucoma medications from 4.07 (SD: 0.26) preoperatively to 0.93 (SD: 1.31) postoperatively (P <0.001). The absolute success rate was 62%, reaching 100% in terms of qualified success. Postoperative complications included vitreous hemorrhage in 4 (13.8%) eyes, transient hypotony in 3 (10.3%) eyes, hyphema in 2 (6.9%) eyes, tube exposure in 2 (6.9%) eyes, and development of a small iris cyst in 1 (3.4%) eye. Conclusion: Pars plana implantation of AGV is a viable option in refractory glaucoma eyes where other surgical options are precluded, as it provides a good success rate with fewer postoperative complications. One must still keep a watch for tube exposure, vitreous incarceration in the tube, vitreous hemorrhage, and future retinal complications.
  3,403 218 -
Effect of neodymium: yttrium aluminum garnet laser posterior capsulotomy on intraocular pressure
Neha Verma, Ashish K Ahuja
2020, 2:6 (24 March 2020)
Objective: To find out whether there exists a correlation between the quantum of energy used and the amount of rise of intraocular pressure (IOP) following neodymium: yttrium aluminum garnet (Nd: YAG) laser capsulotomy. Materials and Methods: A total of 110 patients who had undergone Nd: YAG laser posterior capsulotomy for the management of posterior capsule opacification with a minimum of 3 months following cataract surgery were enrolled after taking written informed consent. After detailed history and ocular examination, Nd: YAG laser capsulotomy was performed. Prelaser IOP was noted. Nd: YAG laser posterior capsulotomy was performed. Laser energy used was noted following which postlaser IOP was also recorded after 1, 2, and 4 h postprocedure. Paired t-test was used for the comparison of means of IOP and energy levels. Receiver operating characteristic analysis was used to predict the cut-off value of energy on the basis of change of IOP from baseline. Results: The mean energy used in the Nd: YAG laser posterior capsulotomy procedure for all patients was 58.57 ± 34.63 mJ. The mean IOP at 1st h follow-up was 15.32 ± 2.91 mmHg, at 2nd h follow-up was 16.24 ± 3.23 mmHg, and at 4th h follow-up was 16.18 ± 3.35 mmHg. At all three follow-ups, the mean change in IOP was found to be statistically significant (P < 0.001). Conclusion: Postlaser IOP rise is minimal and transient; it varies with the amount of energy used.
  3,243 329 -