Posterior segment involvement in systemic lupus erythematosus – A series from South India

Purpose: To report the spectrum of posterior segment manifestations and visual outcomes in a large series of patients with systemic lupus erythematosus (SLE). Methods: Retrospective study at a tertiary referral eye center in south India between 2016 and 2022. Results: Charts of 109 patients diagnosed to have SLE were retrieved from our medical database. Only nine cases of SLE (8.25%) had posterior segment involvement. The male: female ratio was 1:8. The mean age was 28 years. Unilaterality was the most common presentation in eight cases (88.89%). Lupus nephritis was the most common systemic presentation in five cases (55.56%). Antiphospholipid antibodies (APLA) positivity was seen in two cases (22.22%). Ocular manifestations included microangiopathy (cotton wool spots) in one case, occlusive retinal vasculitis with cotton wool spots in four cases (five eyes), optic disc edema with combined venous and arterial occlusion (one case), central retinal vein occlusion with cotton wool spots and hemorrhages (one case), macular edema (four cases), posterior scleritis with optic disc edema and exudative retinal detachment in the posterior pole (one case), and tubercular choroidal granuloma (one case). Treatment included systemic steroids, hydroxychloroquine sulfate (HCQS), and immunosuppression in all cases, blood thinners in two cases, and laser photocoagulation in four cases. HCQS?related retinal toxicity was not seen in any of the 109 cases. Ocular manifestation was the initial presentation of SLE in one case. Visual outcome was poor in three cases. Conclusion: Presence of posterior segment findings in cases with SLE may suggest a severe systemic disease. Early detection and aggressive treatment result in better visual outcomes. Ophthalmologists could play a vital role in guiding systemic therapy.

SARS-CoV-2 virus-induced bilateral acute iris transillumination syndrome: The first case series in literature

Inflammatory events with highly variable clinical features have been reported with the coronavirus disease 2019 (COVID-19) pandemic, which has affected the whole world. Only one case of COVID-19–associated bilateral acute iris transillumination (BAIT) syndrome has been reported in the literature. We present a case series in which we hypothesize that the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have a mechanism similar to the common viruses that cause BAIT, the etiology of which is still unknown.

Prevalence and Determinants of HIV Related Eye in Patients Attending Anti-retroviral Therapy Clinic in Katsina State, Nigeria

Background: HIV and its complication AIDS was a source of serious public health concern that greeted the end of the 20th century. Being a multi-systemic disease, it was also associated with different forms of ocular morbidities of interest. Purpose: To determine the prevalence, patterns and determinants of HIV related eye diseases in patients attending anti-retroviral clinics in Katsina state, Nigeria.Methods: Two hundred and twenty subjects met the inclusion criteria over a six month period. A questionnaire was administered for socio-demographic data, patients’ history, record review and a detailed ophthalmic examination. Data was analysed using SPSS version 20. Parametric and non-parametric assessments were used to assess the relationship of various factors with manifestation of HIV associated eye diseases.Results: Out of 220 respondents, 164 were females. The Male: Female was 1:2.9. The mean age was 28.5 years ± 14.83 SD. About 65.5% of respondents had eye diseases while 46.4% had HIV associated eye diseases. Prevalence of HIV associated eye diseases was found to be 46.4%. The most common types of eye diseases found were Kerato-conjunctivitis Sicca (KCS) 25.5%, conjunctivitis 5.5%, herpes zoster ophthalmicus 3.2%, anterior uveitis 2.7% and molluscum contagiosum 2.3%. Factors found to affect the manifestation of these eye diseases were CD4 cell count, WHO Clinical Stage of the disease and the Presence of eye symptoms.Conclusion: The study showed a high prevalence of HIV associated eye disease. The Patient’s clinical/WHO stage, CD4 cell count and presence of ocular symptoms were shown to have significant association with the ocular manifestation.

Local ocular surface findings in COVID-19 patients without ocular symptoms / Achados locais de superfície ocular em pacientes com COVID-19 sem sintomas oculares

ABSTRACT Purpose: To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). Methods: In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. Results: No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). Conclusions: The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

RESUMO Objetivo: Investigar sintomas oculares subjetivos e medir a secreção lacrimal objetivamente em pacientes com diagnóstico confirmado da doença coronavírus 2019 (COVID-19). Métodos: Vinte e quatro pacientes que sobreviveram à infecção pela COVID-19 e 27 controles saudáveis foram incluídos neste estudo transversal prospectivo. Citologia de impressão da conjuntiva, teste de Schirmer, tempo de separação do filme lacrimal, pontuações de coloração da córnea foram aplicados a todos os participantes. Resultados: Concluiu-se que não houve diferença significativa em relação ao gênero e idade média entre os dois grupos (p=0,484 e p=0,599, respectivamente). A análise dos resultados da citologia de impressão da conjuntiva revelou que a densidade das células do cálice diminuiu, enquanto os linfócitos e neutrófilos aumentaram nos pacientes do grupo COVID-19 quando comparados com os do grupo controle. Quando a classificação de Nelson foi aplicada às amostras de citologia de impressão da conjuntiva, determinou-se que 25% dos pacientes do grupo COVID-19 e 14,8% dos pacientes do grupo controle apresentaram alterações consistentes com grau 2 ou superior. O tempo médio de separação do filme lacrimal, teste de Schirmer e os resultados das pontuações de coloração da córnea foram determinados, diferindo entre o grupo COVID-19 e o grupo controle (p=0,02, p<0,001, and p=0,003, respectivamente). Conclusões: As análises realizadas neste estudo revelaram as alterações conjuntivais patológicas de pacientes com diagnóstico confirmado de COVID-19 e mostraram que é possível que alterações patológicas da superfície ocular ocorram mesmo no final da infecção pela COVID-19, sem a ocorrência de manifestações oculares clínicas significativas.

Neovascular Glaucoma Secondary to Bloch-Sulzberger Syndrome Documented by Retinography and Wide Field Angiography

Aims: To describe a Neovascular Glaucoma Secondary to Bloch-Sulzberger Syndrome.Presentation of Case: A.B.F. female, 23 years old, claimed significant pain sensation and hyperemia in the left eye (LE) for 45 days, without triggering factors. She came to the consultation with a previous diagnosis of Bloch-Sulzberger Syndrome with pigmented lesions in the lower limbs since childhood, being followed up by dermatology since then.Discussion: The diagnosis of IP (Incontinentia Pigmenti) is complex because it mimics other dermatoses. The impairment in other systems, such as the ophthalmic system, with the possibility of loss of vision and functional disability is a reality. The natural history of retinal lesions is not fully understood. Vascular changes seem to start in the first weeks of life and progress after birth for weeks or months, and may stabilize at any stage, leaving numerous sequelae.Conclusions: Incontinentia pigmenti is difficult to diagnose and, at each evolutionary stage, presents many differential diagnoses. Eye injuries can lead to blindness as a consequence of ischemic events that can start soon after birth.

Subconjunctival Dirofilariasis presenting as orbital cellulitis

Background: Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few from the North India, Orissa and Assam. Dogs, cats, foxes and other wild animals are definitive hosts for dirofilaria. Human ocular parasitosis is prevalent in geographical areas where environmental factors and poor sanitary conditions favor parasitism between humans and animals. However, in recent years, migrating population have facilitated the spread of certain parasitic diseases from endemic to non-endemic areas. We report a case of subconjunctival dirofilariasis in a 91-year-old man, who presented with features of orbital cellulitis. An intact live worm, measuring 13.5 cm, was extracted from the subconjunctival space, following which there was prompt resolution of symptoms. Purpose: Given the increase in the frequency of dirofilariasis in humans in recent years, medical practitioners should bear in mind the possibility of ocular dirofilariasis when a patient presents with an ocular or orbital inflammatory lesion. Synopsis: This video illustrates various presentations of ocular dirofilaria and surgical extraction of a live worm from the subconjunctival space. Highlights: Lifecycle and human ocular manifestations of dirofilaria ared elucidated. Rare presentation of subconjunctival dirofilariasis as orbital cellulitis and its resolution following removal of the live worm has been demonstrated.

Congenital Ocular Melanocytosis: Case Report

Aims: To describe Congenital Ocular Melanocytosis.Presentation of Case: LPC, 7 years old, male, brown, with no previous comorbidities, was taken to the ophthalmology outpatient clinic of the Hospital Universit醨io Ant鬾io Pedro, Brazil by parents who alleged the presence of bluish-looking lesions in the sclera of the child's right eye since birth.Discussion: Congenital Ocular Melanocytosis is a rare pathology characterized by an increase in the number, size and pigmentation of melanocytes. Its pathophysiological picture is unknown, but it is believed to be due to an alteration in the migration of melanocytes from the neural crest to the epidermis during the embryonic process. This condition can be complicated by glaucoma and uveal melanoma. Gonioscopy is essential in these cases to assess whether there is pigmentation of the trabeculae, so that the propaedeutics of investigation of glaucoma becomes essential in these patients, since 10% of cases can complicate this condition.Conclusions: Congenital Ocular Melanocytosis early in life and the importance of monitoring these patients should be emphasized. Comprehensive tests are important for early detection and treatment, in order to improve the prognosis and avoid more severe consequences than what can happen from melanocytosis.

Dos manifestaciones oculares de la artritis reumatoide: epiescleritis y escleritis / Two ocular manifestations of Rheumatoid Arthritis: episcleritis and scleritis

La artritis reumatoide es un trastorno inflamatorio sistémico que afecta a las articulaciones, que puede tener varias manifestaciones extraarticulares, incluida la enfermedad ocular inflamatoria. El propósito de este estudio es hacer una descripción general sobre el diagnóstico y el tratamiento de dos manifestaciones oculares de la artritis reumatoide: la epiescleritis y la escleritis, incluida una actualización de las perspectivas del tratamiento. Las manifestaciones oculares, que incluyen epiescleritis, escleritis, queratitis ulcerosa periférica y enfermedad del ojo seco, se pueden encontrar hasta en el 39 por ciento de los pacientes con artritis reumatoide. Si bien no existen consensos ni guías, muchas opciones emitidas desde la práctica reumatológica estarán disponibles para el tratamiento de la escleritis refractaria, una vez descartadas las causas infecciosas, lo que permite un rápido control de la inflamación y evita tanto el daño estructural del ojo como las complicaciones del uso prolongado de esteroides(AU)

Rheumatoid arthritis is a systemic inflammatory disorder that affects the joints, which can have several extra-articular manifestations, including inflammatory eye disease. To provide an overview of the diagnosis and treatment of two ocular manifestations of rheumatoid arthritis: episcleritis and scleritis, including an update on treatment prospects. Ocular manifestations, including episcleritis, scleritis, peripheral ulcerative keratitis, and dry eye disease, can be found in up to 39 percent of rheumatoid arthritis patients. Although there is no consensus or guidelines, many options issued from rheumatology practice will be available for the treatment of refractory scleritis, once the infectious causes have been ruled out, allowing rapid control of inflammation, and avoiding both structural damage to the eye and complications from long-term steroid use(AU)

Uveítis, complicación ocular de enfermedades reumatológicas / Uveitis, ocular complication of rheumatologic diseases

Las espondiloartropatías constituyen una de las causas más frecuentes de uveítis anteriores. Las uveítis asociadas a espondiloartropatías se encuadran dentro del grupo de las uveítis relacionadas con el antígeno de histocompatibilidad HLA-B27. El objetivo de este estudio es presentar una revisión de las uveítis asociadas a las espondiloartropatías seronegativas (espondilitis anquilosante, artropatía psoriásica, artritis reactiva o síndrome de Reiter y enfermedad inflamatoria intestinal), así como la afectación ocular en el contexto de la artritis reumatoide del adulto y la artritis idiopática juvenil. Las manifestaciones oculares, que incluyen epiescleritis, escleritis, queratitis ulcerosa periférica y enfermedad del ojo seco, se pueden encontrar hasta en el 39 por ciento de los pacientes con artritis reumatoide. La uveítis anterior aguda unilateral recidivante es la más frecuente en las espondiloartropatías, y puede ser la forma de inicio de una espondiloartropatía no diagnosticada previamente. La colaboración entre oftalmólogos y reumatólogos o internistas es fundamental para el correcto manejo y tratamiento de estos pacientes(AU)

Spondyloarthropathies are one of the most frequent causes of anterior uveitis. Uveitis associated with spondyloarthropathies fall within the group of uveitis related to the histocompatibility antigen HLA-B27. To present a review of uveitis associated with seronegative spondyloarthropathies (ankylosing spondylitis, psoriatic arthropathy, reactive arthritis or Reiter's syndrome and inflammatory bowel disease), as well as ocular involvement in the context of adult rheumatoid arthritis and arthritis Juvenile idiopathic. Ocular manifestations, including episcleritis, scleritis, peripheral ulcerative keratitis, and dry eye disease, can be found in up to 39 percent of rheumatoid arthritis patients. Recurrent unilateral acute anterior uveitis is the most frequent in spondyloarthropathies, and can be the initiation of a previously undiagnosed spondyloarthropathy. Collaboration between ophthalmologists and rheumatologists or internists is essential for the correct management and treatment of these patients(AU)

Manifestaciones oculares de la toxocariasis en escolares del estado Anzoátegui en Venezuela / Ocular manifestations of toxocariasis in schoolchildren from the state from the Anzoátegui state in Venezuela

RESUMEN El objetivo de este estudio fue determinar manifestaciones oculares de la toxocariasis en escolares. Se realizó un estudio en dos escuelas del estado Anzoátegui en Venezuela en el 2019. Se empleó la prueba de ELISA para determinar los anticuerpos IgG contra Toxocara spp. Las familias completaron un cuestionario y los niños fueron evaluados clínicamente por pediatras y oftalmólogos. Participaron 118 niños, el 18,6% presentó anticuerpos anti-Toxocara spp. Las manifestaciones clínicas con asociación estadísticamente significativa fueron las reacciones alérgicas, epífora y disminución de la agudeza visual. En la evaluación oftalmológica se encontró queratitis, uveítis, iritis, granuloma retiniano, endoftalmitis, amaurosis, leucocoria, desprendimiento de retina y endotropía. Los hallazgos muestran una alta frecuencia de enfermedad ocular en niños con toxocariasis de un estado de Venezuela.

ABSTRACT The objective of this study was to determine ocular manifestations of toxocariasis in schoolchildren. A study was conducted in two schools in the Anzoátegui state in Venezuela in 2019. The ELISA test was used to determine IgG antibodies against Toxocara spp. The families completed a questionnaire, and the children were clinically evaluated by pediatricians and ophthalmologists. 118 children participated, 18.6% presented anti-Toxocara spp. The clinical manifestations with a statistically significant association were allergic reactions, epiphora, and decreased visual acuity. The ophthalmological evaluation found keratitis, uveitis, iritis, retinal granuloma, endophthalmitis, amaurosis, leukocoria, retinal detachment and endotropia. The findings show a high frequency of eye disease in children with toxocariasis from a state of Venezuela.

Ocular Affection as an Extraintestinal Manifestation in Cases of Inflammatory Bowel Disease at the Kafrelsheikh Governorate / Afecção ocular como manifestação extraintestinal em casos de doença inflamatória intestinal

Abstract Introduction The manifestations of inflammatory bowel disease (IBD) are not restricted to the gastrointestinal tract. Musculoskeletal conditions are considered the most common extraintestinal manifestations, followed by mucocutaneous and ocular diseases. Many general practitioners are unaware of the variety and severity of the ocular affection in IBD patients. Objective To assess the prevalence of extraintestinal manifestations in IBD patients at Kafrelsheikh governorate, and to evaluate the different ocularmanifestations and their relationship to the severity of the disease. Methods A cross-sectional study evaluating 120 patients treated at the Kafrelsheikh University Hospital. The diagnosis of IBD was made between December 2018 and December 2019 through clinical, endoscopic and histopathological examinations. All patients were assessed for any extraintestinal manifestation or evidence of ocular affection through slit-lamp examinations, tonometry, visual acuity, and indirect ophthalmoscopy. Results The mean age of the sample was 35.5 ± 13.3 years. In total, 52 (43.3%) patients were male and 68 (56.7%) were female. Ocular manifestations represent ~ 22.5% of extraintestinal manifestations. The most common ocular findings were conjunctivitis (25.8%) and anterior uveitis (10.8%), followed by scleritis (9.2%) and cataract (8.3%). Other extraintestinal manifestations were observed in 41 (34.1%) 29 (29.9%) of ulcerative colitis cases, and 12 (52%) of Crohn disease cases. There was no statistically significant difference in the presence of ocular involvement in relation to the two types of IBD included in the Montreal classification. Conclusion Ocular manifestations in cases of IBD are common and usually nonspecific in presentation. The severity of the IBD does not reflect the severity of the ocular affection.

Resumo Introdução As manifestações da doença inflamatória intestinal (DII) não se restringem ao trato gastrointestinal. Distúrbios musculoesqueléticos são considerados as manifestações extraintestinais mais comuns, seguidos de doenças oculares e mucocutâneas. Muitos clínicos gerais desconhecem a variedade e a severidade das afecções oculares em casos de DII. Objetivo Determinar a prevalência das manifestações extraintestinais em pacientes com DII na província de Kafrelsheikh, no Egito, e avaliar as diferentes manifestações oculares e sua relação com a gravidade da doença. Métodos Um estudo transversal que avaliou 120 pacientes tratados no Kafrelsheikh University Hospital. O diagnóstico de DII foi feito entre dezembro de 2018 e dezembro de 2019 por meio de exames clínicos, endoscópicos e histopatológicos. Por meio de exames de lâmpada de fenda, tonometria, acuidade visual, e oftalmoscopia indireta, todos os pacientes foram avaliados para se determinar a ocorrência de quaisquer manifestações extraintestinais ou afecções oculares. Resultados Amédia de idade da amostra foi de 35,5 ± 13,3 anos. No total, 52 (43,3%) pacientes com DII eram do sexo masculino, e 68 (56,7%), do sexo feminino. As manifestações oculares representaram ~ 22,5% das manifestações extraintestinais. Os achados oculares mais comuns foram conjuntivite (25,8%) e uveíte anterior (10,8%), seguidas de esclerite (9,2%) e catarata (8,3%). Outras manifestações extraintestinais foram observadas em 41 (34,1%) pacientes, entre elas, 29,9% de casos de colite ulcerativa, e 52% de casos de doença de Crohn. Não houve diferença estatisticamente significativa na presença de envolvimento ocular com relação aos dois tipos de DII descritos na classificação de Montreal. Conclusão Asmanifestações oculares empacientes de DII são comuns e, geralmente, não específicas em termos de apresentação. A gravidade da DII não reflete a gravidade da afecção ocular.

A 15-year review of ocular manifestations of autoimmune inflammatory disorders in a university hospital

@#<p style="text-align: justify;"><strong>Background:</strong> Autoimmune diseases represent a significant health burden for 3% to 9% of the general population, and rheumatology, perhaps more than any other medical subspecialty, encompasses a broad array of such diseases that affect a wide range of organ systems including the eye. It serves as a sensitive barometer of autoimmune phenomena in many of the rheumatic diseases.</p><p style="text-align: justify;"><strong>Objective:</strong> The study determined the various ocular manifestations of all autoimmune inflammatory disorders at the University of Santo Tomas Hospital, Section of Rheumatology and the Department of Ophthalmology from 2003 to 2018.</p><p style="text-align: justify;"><strong>Methodology:</strong> A retrospective cohort study was done involving chart review of patients from both private division and clinical division. Sex, age, duration of disease, medications given, and ocular manifestations were determined. Statistical analysis included frequencies, percentages, and logistic regression analysis.</p><p style="text-align: justify;"><strong>Results:</strong> Sixty-seven patients were included in the study. Of these, 58.2% (39/67) had ocular manifestations secondary to an established autoimmune disease. It was found out that 58.97% (23/39) had Vogt-Koyanagi-Harada syndrome. Other autoimmune diseases with ophthalmologic manifestations were systemic lupus erythematosus at 12.8% (5/39), ankylosing spondylitis at 10.25% (4/39), rheumatoid arthritis and Behcet's syndrome at 5.12% (2/39), and granulomatosis with polyangiitis, scleroderma and psoriatic arthritis at 2.56% (1/39).</p><p style="text-align: justify;"><strong>Conclusion:</strong> In this population, the frequency of ocular manifestations of autoimmune diseases remained low with anterior uveitis as the most common. Close coordination between specialties is very important in the course of treatment and management to lessen its complications and related morbidity.</p>

Manifestaciones oftalmológicas de la COVID-19 / Ophthalmological manifestations of COVID-19

RESUMEN La Organización Mundial de la Salud declaró el 11 de marzo del año 2020 pandemia por la COVID-19, enfermedad causada por el SAR-COV-2. Al no existir medicamentos efectivos disponibles para esta infección viral, muchos han sido los esfuerzos de las políticas de salud para lograr un control adecuado de la fuente de infección, la transmisión y la protección en poblaciones susceptible, mediante las cuarentenas obligatorias como medida oportuna de prevención. Hasta el momento la presencia de conjuntivitis viral y el riesgo de contagio por vía ocular son datos mencionados en la literatura internacional en el curso de diversas investigaciones. Se conoce que el virus puede aislarse en la lágrima y en la conjuntiva, y que su transmisibilidad por las secreciones oculares es posible. La actual pandemia del coronavirus es una emergencia sanitaria mundial y muchos países han sido actualmente afectados con miles de fallecidos. Se realizó una búsqueda de diversos artículos publicados, con el objetivo de conocer las manifestaciones oculares de la COVID-19 reportadas por diferentes investigadores. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

ABSTRACT COVID-19, a disease caused by SARS-CoV-2, was declared pandemic by the World Health Organization on 11 March 2020. In the absence of effective medications for this viral infection, many have been the efforts made by health policies to adequately control the source of infection and transmission, and to protect susceptible populations through compulsory quarantine as a timely prevention measure. Viral conjunctivitis and risk of contagion via the ocular route have been mentioned in a variety of international studies contained in the bibliography about the topic. It has been found that the virus may be isolated from tears and from the conjunctiva, and that it may be transmitted via ocular secretion. The current coronavirus pandemic is a world health emergency causing thousands of deaths in many countries. A search was conducted for published papers to identify the ocular manifestations of COVID-19 reported by researchers. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Complicaciones oculares asociadas a la fiebre por dengue / Ophthalmic complications associated to dengue fever

RESUMEN La infección por el virus del dengue va en aumento en las regiones tropicales de Asia, África y América. Se estima que se producen de 50 a 100 millones de casos de esta enfermedad al año. En los últimos tiempos han aumentado los reportes de manifestaciones oculares en estos pacientes, las cuales ocurren en un rango de 5 a 7 días posteriores al inicio de los síntomas, aunque también pueden ocurrir más tarde, y generalmente existe buen pronóstico visual. Se realiza una revisión bibliográfica con el objetivo de ampliar el conocimiento sobre un tema poco tratado en nuestro medio. Se consultaron fundamentalmente artículos científicos de revistas, publicados en las bases de datos PubMED y Cochrane, así como textos básicos que abordan este tema en los últimos 5 años, a través de Google académico como motor de búsqueda. Se constató que se han reportado manifestaciones oculares en pacientes con dengue que van desde hallazgos en el segmento anterior sin afectación visual, hasta cuadros más intensos que interesan las estructuras del polo posterior del ojo. La fisiopatología de estos hallazgos aún se encuentra en estudio y no existe consenso para su tratamiento. A pesar de que el pronóstico visual de estas alteraciones es bueno, se reportan casos donde no es así y se precisa mayor comprensión sobre la fisiopatología de estas para un abordaje terapéutico más adecuado en cada caso(AU)

ABSTRACT Infection by dengue virus is on the increase in tropical regions of Asia, Africa and America. It has been estimated that 50 to 100 million cases of this disease occur every year. Recent years have witnessed a rise in the number of reports of ocular manifestations in dengue patients. These manifestations appear 5 to 7 days after symptom onset, though they could also occur later, and the visual prognosis is generally good. A bibliographic review was conducted with the purpose of broadening knowledge about a topic not commonly dealt with in our environment. The search was mainly aimed at scientific papers from journals, published in the databases PubMed and Cochrane, as well as basic texts addressing the study topic in the last 5 years, using the search engine Google Scholar. Ocular manifestations were found to have been reported in dengue patients. These range from findings in the anterior segment without any visual alteration to more intense episodes affecting the structures of the posterior pole of the eye. The physiopathology of these findings is still being studied, and there is no consensus about its treatment. Despite the good visual prognosis of these alterations, cases have been reported of a different outcome. Therefore, a better understanding is required of their physiopathology to achieve a more appropriate therapy for each case(AU)

Study of Ocular Manifestations among Beta Thalassemia Major Patients

Person with thalassemia major may have severe symptoms and may need regular blood transfusions. Iron overload is due to repeated blood transfusions and enhanced iron absorption by gastrointestinal tract and also creates negative impact on the organs function. We aimed to study the ocular changes in beta thalassemia major at a tertiary care hospital. Methods: In this prospective observational study, 234 patients diagnosed with beta thalassemia major, receiving multiple blood transfusions as a part of treatment were included. Patient brief history was taken, along with family history. Complete eye examination done. Ocular examination done by measuring visual acuity, refractive error assessment with autorefractometer, slit lamp examination, fundoscopy, perimetry, tonometry, color vision testing and tear break up time (TBUT) test. Results: A total of 234 beta thalassemia major patients of both sexes were evaluated, among them 132 (56.4%) were males and 102 (43.5%)were females. The mean age of thalassemic study population was 25.6±6.3. Most commonly observed were pinguecula (44%), visual field defects (40.5%), vascular tortuosity (39.3%), dry eye (33.3%), Refractive error (20.5%), Anterior segment involvement (18.8%), Cataract (13.2%), color vision defect (5.1%), normalization of optical vessels (4%). Conclusion: Regular Opthalmological examination helps to detect early changes due to disease and chelating agents. Issue of iron overload among thalassemic patients can be reduced by decreasing the need or the frequency of blood transfusions.

Manifestações oftalmológicas dos pacientes idosos com infecção pelo vírus da imunodeficiência humana / Ophthalmologic manifestations of elderly patients with human immunodeficiency virus infection

Resumo Objetivos: Identificar e descrever as alterações oculares em idosos com HIV ou aids através de exame oftalmológico. Avaliar a associação entre as alterações oculares encontradas e o nível de linfócitos T CD4, tempo da terapia antirretroviral, características demográficas e faixa etária. Métodos: Série de 40 casos de pacientes idosos com HIV examinados nos serviços de oftalmologia e imunologia do Hospital Universitário Gaffrée e Guinle (HUGG) de janeiro de 2017 a junho de 2018. Foi realizado o seguinte exame oftalmológico: anamnese, acuidade visual, motilidade ocular, reflexo pupilar, biomicroscopia, tonometria de aplanação e fundoscopia. As análises estatísticas foram realizadas pelo SPSS 20.0. Resultados: A média de idade dos 40 pacientes foi 64,7 anos (dp: 5,1) e o diagnóstico de infeção pelo HIV foi em média há 16.6 anos (dp:7). A maioria dos pacientes examinados possui visão normal (n=22; 55%) e pressão intraocular normal (entre 11 e 21 mmHg). As principais queixas dos pacientes durante a anamnese foram: embaçamento visual (50%), redução da acuidade visual (47.5%), prurido ocular (27.5%), lacrimejamento (25%) e ardência (25%). As alterações biomicroscópicas mais frequentes foram catarata (92.5%), seguida de olho seco (32.5%). Na fundoscopia encontrou-se 43,8 % de alterações da vascularização retiniana, 43.8 % de alterações relacionadas ao nervo óptico e 31,3% relacionadas ao pólo posterior da retina. Conclusão: Alterações oculares foram comuns e podem ser justificadas pela: senilidade, estado inflamatório gerado pela infecção crônica do HIV, efeitos adversos da Terapia antirretroviral prolongada e senescência biológica precoce associada a infecção do HIV.

Abstract Objectives: Identify and describe ocular changes in elderly with HIV or aids through ophthalmological examination. Evaluate the association between ocular alterations and the level of TCD4 lymphocytes, time of antiretroviral therapy, demographic characteristics and age range. Methods: Case series of 40 elderly patients with HIV infection. The study was carried out at the ophthalmology and immunology outpatient clinics of the Gaffrée and Guinle University Hospital (HUGG) from january 2017 to june 2018. The patients were attended at the ophthalmology clinic and underwent a ophthalmological exam including: anamnesis, visual acuity, ocular motility, pupillary reflex, biomicroscopy, aplanation tonometry and fundoscopy. Statistical analyses were performed using SPSS 20.0. Results: The average of the 40 patients was 64.7 years (sd: 5.1), aged between 60 and 78 years, and the average time of HIV infection was 16.6 years (sd: 7 years). Most of the patients examined had normal vision (55%) and normal intraocular pressure (between 11 and 21 mmHg). The main complaints of patients during anamnesis were visual blurring (50%), visual acuity reduction (47.5%), ocular itchiness (27.5%), tearing (25%) and burning (25%).The most frequent changes in biomicroscopy were: cataract (92.5%) and dry eye (32.5%). Funduscopy found 43.8% of retinal vascularization alterations, 43.8% of alterations related to the optic nerve and 31.3% related to retinal posterior pole. Conclusion: Ocular changes were common and can be explained by senility, inflamatory changes caused by chronic HIV infection, adverse effects of antiretroviral therapy and early biological ageing associated to HIV infection.

Research progress of ocular manifestations and pathological mechanisms in Alport syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#Alport syndrome(AS)is a genetic disease characterized by abnormal basement membrane structure of the kidneys, ears and eyes. The incidence of the disease is 1:5000 approximately. The report on ocular manifestations is relatively scarce, however, it is of great value to diagnosis of the disease. The ocular tissue histopathological analysis provides an effective method to uncover the pathological mechanisms of AS. Besides, it is good for understanding and treatment of AS.

Morning glory disc anomaly and facial hemangiomas in a girl with moyamoya syndrome

Moyamoya disease (MMD) is a chronic progressive, occlusive cerebrovascular disease in the circle of Willis and the feeding arteries. Morning glory disc anomaly (MGDA) is characterized by an abnormal excavated optic disc with radial emergence of blood vessels from the rim of the disc. We describe a case of moyamoya syndrome (MMS), a rare entity among Indian ethnicity, associated with MGDA and regressed facial capillary hemangiomas, which are relatively less reported presentations of MMD. This report emphasizes on the role of neuroimaging in MGDA, so as to facilitate early detection and management of life-threatening intracranial pathologies such as MMS.

Trichothiodystrophy: a case report of childhood glaucoma associated with non-acquired systemic disease / Tricotiodistrofia: relato de caso de glaucoma infantil associado a doença sistémica não adquirida

ABSTRACT Trichothiodystrophy belongs to a group of rare genetic diseases characterized by DNA repair anomalies. Ocular manifestations can occur in 50% of cases, including cataract, refractive errors, strabismus, microcornea, microphthalmia, dry eye, and pigmentary macular changes. We report a case of childhood glaucoma in a patient with trichothiodystrophy who underwent trabeculectomy in the left eye. To our knowledge, this is the first clinical report of childhood glaucoma associated with trichothiodystrophy.

RESUMO A tricotiodistrofia pertence a um grupo de doenças genéticas raras caracterizadas por anomalias da reparação do DNA. Manifestações oculares podem ocorrer em 50% dos casos, incluindo catarata, erros refrativos, estrabismo, microcórnea, microftalmia, olho seco e alterações maculares pigmentares. Relatamos um caso de glaucoma infantil em um paciente com tricotiodistrofia submetido à trabeculectomia no olho esquerdo. No nosso conhecimento, este é o primeiro caso descrito de glaucoma infantil associado à tricotiodistrofia.