ABSTRACT
Purpose: The COVID-19 pandemic affected medical practice worldwide due to interventions to prevent spreading. Its effect on ophthalmology practices in Latin America has not yet been explored. We aimed to assess the perceptions about the pandemic from countries' ophthalmological national and subspecialty retina societies affiliated to the Pan-American Association of Ophthalmology (PAAO). Patients and Methods: A survey-based study of leaders of national ophthalmological and retinal societies was conducted. The survey was sent by email to 30 societies, from which 20 responded (12 countries, 66.6% response rate). It included closed- and open-ended questions about (1) operational capacity and precautions, (2) telemedicine and virtual care, (3) procedures, and (4) post-pandemic considerations. Results: There was a marked decline in ophthalmology patient visits (80-95%) and elective surgeries (90%) during 2020 compared to before the pandemic. Precautions like temperature checks, mask usage, and social distancing were widely implemented while personal protective equipment (PPE) availability varied. Telemedicine use was limited due to lack of experience with it. Reopening plans focused on maintaining precautions and gradually resuming activities. Economic and security concerns were raised, and adherence to guidelines was emphasized. Respondents acknowledged the need to adapt to a "new normal". Long duration drugs, fewer imaging studies, and shorter wait times were preferred; however, availability of long duration drugs was limited. Conclusion: The pandemic impacted ophthalmology in Latin America, with reduced patient visits, procedures, and surgeries. Delayed treatment and complications were likely the result of the pandemic.
ABSTRACT
Corneal wound healing studies have been conducted for a long time and have helped to reduce suffering and develop treatments that contribute to improving patients' eye health. Historically, corneal healing has been studied in rodents such as mice and rats, but these models might not completely mimic human disorders. However, information on other rodents such as Mongolian gerbils (Meriones unguiculatus) is scant in corneal research. Here, we describe a technique to develop a novel animal model for studying corneal healing after photorefractive keratectomy. Due to the limited literature available on the cornea of M. unguiculatus, we also describe a histological analysis of the normal cornea. These research techniques can also be employed in the study of eye diseases because of the similarity between the corneas of Mongolian gerbils and humans in terms of genetics, anatomy, and physiology.
Subject(s)
Cornea , Photorefractive Keratectomy , Humans , Animals , Mice , Rats , Gerbillinae , Cornea/surgery , Wound Healing/physiology , Models, AnimalABSTRACT
La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis.El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.
Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, post-surgical perinatal complications, or sepsis.This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.
Subject(s)
Humans , Female , Infant, Newborn , Endophthalmitis/diagnostic imaging , Postoperative Complications , Endophthalmitis/therapy , Enterobacter cloacae , SepsisABSTRACT
Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, postsurgical perinatal complications, or sepsis. This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.
La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis. El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.
Subject(s)
Endophthalmitis , Premature Birth , Sepsis , Endophthalmitis/etiology , Female , Humans , Infant, Newborn , PregnancyABSTRACT
Fungal keratitis is an ocular infection that has no standardized treatment. The etiological agents most frequently reported in the literature are Fusarium spp., Aspergillus spp., Alternaria spp. and Curvularia spp., related to injuries and Candida albicans related to contact lens wear. Here we present a case of bilateral fungal keratitis of a few days of evolution with insufficient response to antifungal pharmacological treatment and with early application of cross-linking in both eyes as an adjuvant therapy. A review of the current status of cross-linking for the treatment of corneal infections is presented.
ABSTRACT
El Cross-Linking corneal es un procedimiento utilizado en oftalmología principalmente para el tratamiento del queratocono, la ectasia corneal más frecuente. A pesar de su baja tasa de complicaciones, no es una técnica exenta de ellas. Entre las principales complicaciones se encuentran el haze y el melting corneal, ambas poseen una fisiopatología que no está totalmente esclarecida. Se realizó una revisión bibliográfica sobre la asociación entre el uso de quinolonas y el daño corneal frente a la exposición de luz UV. También se plantearon factores inherentes al paciente que se han relacionado al aumento de complicaciones. Se determinó que la radiación UV produce daños en aquellos tejidos sometidos previamente a tratamiento con quinolonas siendo de suma importancia la correcta anamnesis para seleccionar a los candidatos al procedimiento. (AU)
Corneal Cross-Linking is a procedure used in ophthalmology mainly for the treatment of keratoconus, the most frequent corneal ectasia. Despite its low complication rate, it is not an exempt technique. Among the main complications are haze and corneal melting, both have a pathophysiology that is not fully clarified. A bibliographic review of the association between the use of quinolones and corneal damage versus UV light exposure was performed. Inherent patient factors that have been related to increased complications were also raised. It was determined that UV radiation causes damage to these tissues, sometimes prior to quinolone treatment, with the correction of the anamnesis being of utmost importance to select the candidates for the procedure.
Subject(s)
Humans , Cornea/abnormalities , Cross-Linking Reagents/therapeutic use , Riboflavin/therapeutic use , Risk Factors , Keratoconus/drug therapyABSTRACT
The higher prevalence rates of depression in visually-impaired individuals than the general population indicates that the condition per se increases the risk of depression. A person that is aware of the progressive loss of visual acuteness may have feelings of insecurity, anxiety, loss of independence and changes in social functioning, leading to depression. Several studies assessing the association between depressive symptoms and severity of vision loss have yielded inconsistent results. Some do not show any association, whereas others reported that depression severity is higher in those with substantial vision loss. The general aim of this manuscript was to determine the prevalence of depression in patients diagnosed with legal blindness in the Eye Care Service at the Hospital Córdoba between June 2016 and June 2017. The study sample consisted of 41 patients. The level of depression was assessed using the Zung scale and the degree of dependence in daily life activities was defined using the Barthel index. Data was anonymized for inclusion in a computer database and statistical confidentiality was protected. Data was analyzed using InfoStat statistical software. The results revealed a relation between legal blindness, degrees of dependency and depressive symptoms in patients of the Eye Care Service of the Hospital Córdoba. It is very important for health professionals to be trained to detect early signs and symptoms of depression and have the necessary tools for such an approach.
ABSTRACT
This work reports on a clinical case of a female who presented with headache, bilateral eye pain and vision loss. Intraocular pressures were 40 mm Hg in the right eye and 45 mm Hg in the left eye. Optical Coherence Tomography examination shows the iridocorneal angle was collapsed and macular striae were also observed. The patient had been on topiramate due to migraines 7 days before presentation. Diagnosis for topiramate-induced acute angle closure was made in both eyes. The patient showed improvement in symptoms a few days after treatment initiation and images confirmed that the iridocorneal angle had been enlarged and macular striae had disappeared.
ABSTRACT
PURPOSE: Corneal crosslinking by UV light (UV-CXL) has become a popular treatment for keratoconus and corneal ectasia. Fluoroquinolones (FQs), commonly administered topically before UV-CXL, are known to be phototoxic to the skin and lens. The purpose of this study was to investigate phototoxic effects of topical FQ treatment on murine corneas before UV-CXL, in which the corneal epithelium was kept intact. METHODS: Murine corneas were treated with various antibiotics with or without riboflavin before UV-CXL. At 24 h, the animals were sacrificed, and the corneas were analyzed for histologic evidence of inflammation and apoptosis and for expression of apoptosis markers BAX and caspases 3 and 9 and for expression of matrix metalloproteinase 9 (MMP-9). Spectrofluorometric analysis was performed. RESULTS: Corneas treated with topical FQ with or without riboflavin before UV-CXL showed mild corneal stromal inflammation, apoptosis by both terminal deoxynucleotidyl transferase dUTP nick end labeling staining and increased expression of BAX gene and caspases 3 and 9 by densitometric analysis. Untreated corneas, corneas treated with azithromycin before UV-CXL, and corneas undergoing UV-CXL without any antibiotic or riboflavin pretreatment showed normal histology, no staining for apoptosis, and no increased production of apoptosis markers by polymerase chain reaction. CONCLUSIONS: The phototoxic effects of FQs on the cornea may lead surgeons to consider another antibiotic class for prophylaxis against infectious keratitis in UV-CXL. These effects, along with the known cytotoxic effects of FQs independent of UV radiation, may contribute to some of the complications of corneal UV-CXL. Dosage studies may be warranted.
Subject(s)
Anti-Bacterial Agents/pharmacology , Cornea/drug effects , Cross-Linking Reagents/pharmacology , Fluoroquinolones/toxicity , Photosensitizing Agents/toxicity , Riboflavin/pharmacology , Administration, Topical , Animals , Anti-Bacterial Agents/administration & dosage , Apoptosis/drug effects , Cornea/pathology , Cross-Linking Reagents/administration & dosage , Fluoroquinolones/administration & dosage , Inflammation/drug therapy , Inflammation/pathology , Mice , Models, Animal , Photosensitizing Agents/administration & dosage , Riboflavin/administration & dosage , Ultraviolet RaysABSTRACT
A 57-year-old woman presented to her ophthalmologist because of rapid deterioration in vision. Dilated funduscopic examination of the right eye showed an elevated, yellow-orange choroidal mass temporal to the fovea; a complete retinal detachment was present in the left eye. The patient was referred to an oncologist. Computerized tomography of the brain, thorax, abdomen, and pelvis were obtained. They revealed an 11-mm mass in the right parietal lobe, a 30-mm mass in the left temporal lobe, 23-mm mass in the right kidney, and multiple nodules in both lungs. Supported by published experience with intravitreal bevacizumab for choroidal metastasis, the patient was injected into the vitreous through the pars plana of the left eye. The tumor mass did not show signs of regression and the visual acuity was unchanged. The patient suffered from end-state complications tumor metastasis and expired one month after the invitreal injection.
ABSTRACT
A 52-year-old man presented with a 5-year history of multiple bilateral apocrine hidrocystomas of the eyelids. For the past 3 years, the patient had developed a mechanical ectropion of the right inferior eyelid secondary to progressive enlargement of the lesions. Different therapeutic options were discussed with the patient. Surgical excision of all lesions was performed under local anesthesia. There was no recurrence after 15 months of follow-up.
Subject(s)
Eyelid Neoplasms/pathology , Hidrocystoma/pathology , Neoplasms, Multiple Primary/pathology , Sweat Gland Neoplasms/pathology , Blepharoplasty , Eyelid Neoplasms/surgery , Hidrocystoma/surgery , Humans , Male , Middle Aged , Neoplasms, Multiple Primary/surgery , Sweat Gland Neoplasms/surgeryABSTRACT
PURPOSE: To describe a patient who noticed a corneal growth and accompanying rapid decrease in visual acuity soon after undergoing hyperopic photorefractive keratectomy (PRK). METHOD: Interventional case report. RESULTS: A healthy 47-year-old white woman presented with a corneal growth after undergoing PRK. Visual acuity became progressively worse over 2 years. The growth transected the visual axis, measuring 180 µm centrally and 310 µm nasally. She underwent excisional biopsy, application of mitomycin C on the limbus and adjacent corneal tissue, and grafting with cryopreserved multilayer amniotic membrane. The pathologist reported findings consistent with pterygium. The patient initially experienced improvement in uncorrected visual acuity but then became noncompliant with topical steroids. The central anterior stroma became opacified to the extent of obscuring iris details. Best-corrected visual acuity at the last follow-up was 20/30. CONCLUSIONS: Because ultraviolet exposure is a risk factor for development and growth of pterygium, 1 possible explanation for this patient's findings is the effect of the excimer laser (which has a wavelength in the ultraviolet spectrum) on a previously insignificant corneal growth and/or the corneal limbal stem cells. Patients with corneal lesions suggestive of pterygia may be at increased risk for rapid lesion growth and aggressive corneal scarring after photorefractive keratectomy with a large ablation zone.
Subject(s)
Cicatrix/etiology , Corneal Diseases/etiology , Hyperopia/surgery , Photorefractive Keratectomy/adverse effects , Pterygium/pathology , Cicatrix/drug therapy , Cicatrix/physiopathology , Corneal Diseases/drug therapy , Corneal Diseases/physiopathology , Corneal Stroma/pathology , Female , Glucocorticoids/administration & dosage , Humans , Medication Adherence , Middle Aged , Pterygium/drug therapy , Tomography, Optical Coherence , Vision Disorders/etiology , Visual Acuity/physiologySubject(s)
Disease Outbreaks/prevention & control , Health Care Rationing/organization & administration , Influenza A Virus, H1N1 Subtype/physiology , Influenza, Human/epidemiology , Ophthalmology , Resource Allocation/organization & administration , Argentina , Hospitals, Public , Humans , Triage , WorkforceABSTRACT
PURPOSE OF REVIEW: To examine whether wavefront-guided refractive surgery has a role in correcting ametropia after implantation of multifocal intraocular lenses (IOLs). RECENT FINDINGS: This review begins with an oversight of various multifocal IOLs to help understand how a wavefront might return from the IOL and be captured by an aberrometer. The accuracy of the wavefront may be compromised in eyes with multifocal IOLs by the fact that such lenses provide simultaneous vision--that is, a simultaneous projection of in-focus and out-of-focus images of an object on the retina--and hence returning wavefronts theoretically could be captured in a similar manner by an aberrometer. However, in isolated small series, reproducible wavefront refractions--in which the manifest refraction closely approximates the wavefront refraction and good results after refractive surgery--are attained in eyes with diffractive multifocal IOLs. SUMMARY: Small studies suggest that it is possible to perform wavefront-guided excimer light amplification by stimulated emission of radiation (LASER) to correct ametropia following multifocal lens implantation. Larger studies with longer follow-up are needed to determine whether eyes with multifocal lenses derive an added benefit from wavefront-guided refractive surgery over conventional surgery. These studies may help determine whether some IOLs are better suited for subsequent refractive surgery. The age of the patient may affect the outcome of refractive surgery after multifocal IOL implantation.
Subject(s)
Corneal Surgery, Laser/methods , Lens Implantation, Intraocular , Postoperative Complications , Refractive Errors/therapy , Age Factors , Humans , Treatment Outcome , Visual AcuityABSTRACT
Purpose. To describe the presence of secretory leukocyte protease inhibitor (SLPI), a cationic peptide with antimicrobial and antiprotease activity in the innate immune reaction in a rat model of Staphylococcus aureus keratitis. Methods. Forty female Lewis rats were divided into 2 groups: the infectious keratitis and the epithelial defect groups. Eyes were processed for immunohistochemical studies for SLPI, interleukin-1, interleukin-6, tumor necrosis factor-alpha, and matrix metalloproteinase-8. Results. Immunohistochemical studies confirmed high levels of SLPI, IL-1, IL-6, TNF-alpha, and MMP-8 expression in eyes with S. aureus keratitis and with epithelial defects, in contrast to undetectable SLPI expression in the normal control corneas. Conclusions. To our knowledge, this paper is the first to demonstrate the presence of SLPI with increased amounts of proinflammatory cytokines in inflamed and infected corneas.
Subject(s)
Adenocarcinoma/drug therapy , Angiogenesis Inhibitors/therapeutic use , Antibodies, Monoclonal/therapeutic use , Choroid Neoplasms/drug therapy , Colorectal Neoplasms/drug therapy , Adenocarcinoma/secondary , Aged , Antibodies, Monoclonal, Humanized , Bevacizumab , Choroid Neoplasms/secondary , Colorectal Neoplasms/pathology , Female , Fluorescein Angiography , Fovea Centralis , Humans , Injections , Remission Induction , Tomography, X-Ray Computed , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vitreous BodyABSTRACT
We report a case of acute rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) surgery in a highly myopic patient. Fourteen hours postoperatively, the uncorrected visual acuity was counting fingers in the left eye. Slitlamp examination revealed significant anterior chamber reaction with fibrin-like material. Fundus examination revealed 2 inferior retinal horseshoe tears associated with an RD. Preoperative fundus examination with scleral depression may detect predisposing retinal lesions in highly myopic patients. Further study is required to evaluate the relationship between LASIK, acute postoperative RRD, and predisposing factors.
