Ophthalmology practice during the COVID-19 pandemic.

OBJECTIVE: To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS: Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULTS: A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION: Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.

Frosted branch angiitis complicated by retinal vein occlusion: clinical course and long-term visual outcome.

PURPOSE: Frosted branch angiitis (FBA) is a rare entity characterized by acute panuveitis in the form of a florid translucent retinal perivascular sheathing of both arterioles and venules, with variable uveitis, retinal edema and visual loss. Primary and secondary cases have been described in association with infectious, inflammatory and malignant etiologies. We aim to describe the clinical course and long-term visual outcome of three patients who developed retinal vein occlusion (RVO) and macular edema as a complication of FBA. METHODS: Descriptive case series. RESULTS: Three young healthy patients aged 22, 37 and 45 years presented with sudden visual disturbance secondary to unilateral primary FBA, which improved significantly following high-dose steroid therapy. Several weeks later, RVO developed, with marked cystoid macular edema. Visual improvement was achieved and maintained with anti-VEGF therapy over a follow-up period ranging from 14 to 44 months. CONCLUSION: FBA may be considered a risk factor for the development of secondary RVO because of the severe retinal vasculitis that eventually leads to activation of the coagulation system and retinal thrombosis. It remains to be determined whether antiplatelet therapy needs to be administered prophylactically in such a scenario in order to reduce the risk or prevent the development of RVO.

Results of CO2 Laser-assisted Deep Sclerectomy as Compared With Conventional Deep Sclerectomy.

PURPOSE: To evaluate the efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) compared with classic nonpenetrating deep sclerectomy (NPDS) with implant in medically uncontrolled glaucoma patients. MATERIALS AND METHODS: Patients who underwent primary filtration surgery with CO2 laser system at the time interval between July 2010 and April 2011 were identified, their medical files were reviewed, and their results were compared with matched control group who underwent classic NPDS with intrascleral implant at the same time period. Intraocular pressure (IOP) was measured at baseline, 1 week, and 3, 6, 12, 18, and 24 months, respectively. Main outcome measures were: IOP, use of supplemental medical therapy, and failure (5 mm Hg>IOP>18 mm Hg, reoperation for glaucoma, or loss of light perception). RESULTS: A total of 58 patients were reviewed, including 27 in the CLASS group and 31 in the NPDS group. For the CLASS group the follow-up (mean±SD) was 20.7±6.8 months, the mean preoperative IOP was 23.3±8.2 mm Hg (range, 10 to 38 mm Hg), and the mean number of antiglaucoma medication before surgery was 3.0±1.0 (range, 1 to 4). At final follow-up visits, the mean IOP was 11.7±3.1 mm Hg (range, 6 to 19 mm Hg), and the mean number of antiglaucoma medication was reduced to 1.0±1.6 (P<0.0003). The complete success rate (IOP≤18 mm Hg without antiglaucoma medication) was 73% and the qualified success rate (IOP≤18 mm Hg with/without antiglaucoma medication) was 96%. For the control group the mean follow-up was 17.6±6.7 months, the mean preoperative IOP was 23.1±7.3 mm Hg (range, 14 to 44 mm Hg), and the mean number of antiglaucoma medication before surgery was 3.0±0.8 (range, 1 to 4). At final follow-up visits, the IOP was 13.3±3.6 mm Hg (range, 8 to 20 mm Hg), and the mean number of antiglaucoma medication was reduced to 0.7±1.1 (P<0.0004). The complete success rate and the qualified success rate were 71% and 89%, respectively. CONCLUSIONS: A new technique using a CO2-laser ablation system allows precise and easy creation of the scleral space and ablation of Schlemm canal. This technique has been shown to be as efficient as the standard NPDS surgery in terms of IOP-lowering effect. This would render the deep sclerectomy an easier glaucoma surgery.

Refractive profile in oculocutaneous albinism and its correlation with final visual outcome.

PURPOSE: To evaluate the prevalence of refractive errors in different subtypes of oculocutaneous albinism, and to see if there is any correlation between refractive errors and final visual outcome in this population. PATIENTS/METHODS: This is a retrospective study of 132 albino patients, ranging in age from 0.5 to 35 years. They were divided into four subtypes: OCA1A, OCA1B and OCA1C, and OCA2. Refractive errors were evaluated objectively by cycloplegic refraction and subjectively in cooperative patients. Best corrected visual acuity was assessed binocularly. Refractive errors were divided into three groups--hypermetropia, myopia and astigmatism--to avoid the use of spherical equivalent. RESULTS: Refractive errors were mainly astigmatism and hypermetropia. The OCA1A group showed high hypermetropia (≥ 5 dioptres) in 43.4% of patients, reaching significantly higher levels than in other subgroups (p=0.007). Mean visual acuity in logMAR was: OCA1A=0.81, OCA1B=0.64, OCA1C=0.61 and OCA2=0.48. Astigmatism averaged 2.1 dioptres (consistently with-the-rule), and it was homogeneously distributed between all subgroups (53%). CONCLUSIONS: The poorest visual acuity was found in those with OCA1A, which was associated with the highest rate of high hypermetropia (statistically significant different from other subgroups). Astigmatism was the most common visually significant refractive error across all subtypes of albinism. These results may help to clarify the prevalence of refractive errors in albino patients and aid the prediction of visual outcome in this heterogeneous population.