Primary Cancer Sites and Clinical Features of Choroidal Metastasis in Mexican Patients.

PURPOSE: To describe the primary cancer sites and clinical features of choroidal metastasis in Mexican patients. METHODS: This was a retrospective, observational, and multi-center study. Data were recollected from 6 ophthalmological hospitals in Mexico from patients with choroidal metastasis diagnosed from 2000 to 2018. RESULTS: Seventy-eight patients were studied: 43 were female and 35 were male. Mean age at presentation was 57.6 years. Overall, primary cancer sites were: 1) breast: 27 cases (34.6%); 2) lung: 19 cases (24.3%); 3) unknown: 8 cases (10.2%); 4) gastrointestinal: 7 cases (8.9%); 5) renal: 5 cases (6.4%); 6) testicular: 3 cases (3.8%); 7) ovary: 3 Cases (3.8%); 8) prostate: 2 cases (2.5%); 9) thyroid: 2 cases (2.5%); 10) carcinoid: 1 case (1.2%); and 11) multiple myeloma: 1 case (1.2%). Divided by gender, for women, the main three sites were: breast, unknown, and ovary. For men, the main three sites were: lung, gastrointestinal, and testicular. Oldest cases were breast cancer (87 and 85 years); youngest cases were testicular (23 and 25 years). Solitary lesions were observed in 56 cases (71.7%); multiple lesions were observed in 22 cases (28.2%). Forty-two cases had a white or yellowish color, while 6 cases presented an orange color. CONCLUSION: Primary cancer sites and clinical features of choroidal metastasis in Mexican patients show important differences from other populations previously studied, mainly the presence of a higher proportion of gastrointestinal and renal cancer, as well as higher incidence of ovarian and testicular cancer. These types of cancer, although not as common as breast or lung, need to be taken into account when studying Mexican patients living abroad.

Oxymetazoline: reduction of subconjunctival hemorrhage incidence after intravitreal injections.

OBJECTIVE: Subconjunctival hemorrhage (SCH) is an important minor side effect that might affect patient compliance to antivascular endothelial growth factor (anti-VEGF) intravitreal injection treatment (IVI). We sought to compare SCH incidence and pain score responses after topical oxymetazoline in naïve patients undergoing a single IVI of ranibizumab for diabetic macular edema. METHODS: Prospective, randomized, double-blinded, single centre study. One hundred two patients naïve to anti-VEGF were assigned to receive either topical oxymetazoline or placebo 30 minutes before IVI. SCH incidence and area were measured by slit lamp 24 hours after, and pain was evaluated 5 minutes and 24 hours after. RESULTS: SCH incidence was reported on 72% in control group versus 51% in oxymetazoline group (p = 0.037). Mean size of SCH was 16.82 mm2 in control group versus 12.55 mm2 in oxymetazoline group (p = 0.394). Prevalence of local pain in the overall study population was 60%. No significant statistical difference was achieved between groups 5 minutes or 24 hours after IVI in either pain scale evaluation. CONCLUSION: Administration of topical oxymetazoline 30 minutes before IVI is a single, harmless, cost-effective intervention that decreases the incidence of subconjunctival hemorrhage. This may considerably improve patient treatment satisfaction and promote compliance to IVI therapy.

Comparison of anatomic and functional success of treatment for retinal detachment with macular involvement between two retinopexy techniques.

OBJECTIVE: To compare the frequency of anatomic and functional success, between eyes with uncomplicated rhegmatogenous retinal detachment treated with exoplant or vitrectomy. METHOD: Non-experimental, retrospective, comparative and longitudinal study in patients with rhegmatogenous retinal detachment, <20/200 visual acuity and macular involvement, treated with exoplant (group 1) or vitrectomy (group 2), and 9 months follow up, without proliferative vitreoretinopathy or other vitreoretinal disease that reduced vision. The frequencies of anatomic success (attached retina) and functional success (visual acuity > 20/200) were compared between groups at the end of follow up (chi squared and odds ratio). RESULTS: 114 patients, mean age 48.5 ± 16.6 years, mean detachment duration 49.8 ± 32.0 days; group 1 had 33 subjects (28.9%) and group 2 had 81 (71.1%). Anatomic success was achieved in 27 subjects of group 1 (81.8%; 95% confidence interval [95% CI]: 68.7-95) and in 74 of group 2 (91.4%; 95% CI: 85.2-97.5; p = 0.1); 14 subjects of group 1 (42.4%) and 21 of group 2 (25.9) had functional success (p = 0.1). DISCUSSION: In our media, the frequencies of anatomic and functional success after treating rhegmatogenous retinal detachment did not differ between exoplant and vitrectomy. Early detection should be favored, to increase the frequency of postoperative visual improvement.

OBJETIVO: Comparar las frecuencias de éxito anatómico y funcional en ojos con desprendimiento de retina regmatógeno no complicado tratados con exoplante o vitrectomía. MÉTODO: Estudio observacional, retrospectivo, comparativo y longitudinal, en pacientes con desprendimiento de retina regmatógeno, agudeza visual < 20/200 y afección macular, tratados con exoplante (grupo 1) o vitrectomía (grupo 2), y seguimiento por 9 meses, sin vitreorretinopatía proliferativa ni otras enfermedades vitreorretinianas que redujeran la visión. Se compararon las frecuencias de éxito anatómico (retina aplicada) y funcional (agudeza visual > 20/200) al final del seguimiento (ji al cuadrado y razón de momios). RESULTADOS: 114 pacientes, edad promedio 48.5 ± 16.6 años, duración promedio del desprendimiento 49.8 ± 32.0 días, 33 casos en el grupo 1 (28.9%) y 81 en el grupo 2 (71.1%). Hubo éxito anatómico en 27 casos del grupo 1 (81.8%; intervalo de confianza del 95% [IC 95%]: 68.7-95.0) y en 74 del grupo 2 (91.4%; IC 95%: 85.2-97.5; p = 0.1); 14 casos del grupo 1 (42.4%) y 21 del grupo 2 (25.9%) tuvieron éxito funcional (p = 0.1). DISCUSIÓN: En nuestro medio, las frecuencias de éxito anatómico y funcional después de tratar el desprendimiento de retina regmatógeno no difieren entre el exoplante y la vitrectomía. Debe favorecerse la detección temprana para aumentar la frecuencia de mejoría visual posoperatoria.

Single-Spot Yellow Laser Versus Conventional Green Laser on Panretinal Photocoagulation: Patient Pain Scores and Preferences.

BACKGROUND AND OBJECTIVE: Panretinal photocoagulation (PRP) is the mainstay therapy for proliferative diabetic retinopathy. Pain during and after its application is a complication that affects patients' therapeutic adherence. This study aimed to compare pain perception and patient preference for the 577-nm yellow laser (YL-577) (LIGHTL as 577; LIGHTMED, San Clemente, CA) and the conventional 532-nm green laser (GL-532) (Purepoint Laser; Alcon, Fort Worth, TX) with PRP. PATIENTS AND METHODS: A total of 92 patient eyes with proliferative diabetic retinopathy treated with PRP were randomly assigned to receive both GL-532 and YL-577 (184 eyes) - one on each eye, with the order of application randomized, as well. Afterward, verbal rapid answer and visual analogue scale (VAS) scores for pain perception and patient preference were evaluated. RESULTS: VAS score was 7 ± 2 for the GL-532 group compared to 5 ± 3 in the YL-577 group (P = .001). Overall, 75% of the patients preferred YL-577 therapy if they were to receive a second PRP session. CONCLUSION: The use of YL-577 as an alternative approach for PRP reduces pain perception and is preferred by patients. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:902-905.].

Riley-Day Syndrome in a Hispanic Infant of Non-Jewish Ashkenazi Descent.

Riley-Day syndrome is an autosomal recessive sensory and autonomic neuropathy. Patients present a lack of fungiform papilla, alacrima and usually feeding difficulties. It is present almost exclusively in Ashkenazi Jewish individuals and has a poor prognosis. We describe an unusual case of Riley-Day syndrome with pseudostrabismus in a non-Ashkenazi Jewish patient. A one-year-old female infant was referred for evaluation of strabismus, absence of fungiform papillae, feeding difficulty, gastroesophageal reflux and episodes of self-mutilation. Deep tendon reflexes were depressed, the blinking rate and corneal reflex were diminished as well and corneas were opaque due to corneal erosions. Reduced lacrimal production was confirmed by the Schirmer test. Eye drops were recommended every 2-3 hours for corneal erosion and the patient was referred to the genetics department for further diagnostic confirmation.