CAROTID CAVERNOUS SINUS FISTULA FINDINGS IN OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER PERCUTANEOUS EMBOLIZATION.

BACKGROUND/PURPOSE: Optical coherence tomography angiography has been used to evaluate the posterior segment in a wide variety of pathologies because it is a noninvasive image technique, but its role in the evaluation of the retina in a case of carotid cavernous sinus fistula has not been described yet. METHODS RESULTS: We present a patient who consulted with spontaneous left superior eyelid hematoma and was diagnosed with left indirect carotid cavernous sinus fistula. In this study, optical coherence tomography angiography was used to evaluate the different macular capillary plexuses in a patient with carotid cavernous sinus fistula and a clinical situation of secondary local venous stasis before and after percutaneous embolization. Augmented vessel density was seen in superficial and deep capillary plexuses and in choriocapillaris before the percutaneous embolization, and a decrease of the parameters was seen after the treatment. CONCLUSION: All macular capillary plexuses presented with augmented vessel density levels that normalized after treatment. These findings were previously undescribed, and they suggest that optical coherence tomography angiography may be useful to initially evaluate patients with carotid cavernous sinus fistula who are planned to undergo embolization and to follow them up until normalization of the vascular structures is reported.

A Case of Sterile Corneal Stromal Infiltration with Hypotonic Maculopathy Under Brimonidine Treatment.

INTRODUCTION: Brimonidine is a commonly used drug for glaucoma treatment, which has been linked to ocular autoimmune disorders like uveitis and conjunctivitis. Corneal pathology under brimonidine is generally less common. CASE DESCRIPTION: Here, we report a 78 -year-old male patient suffering from immune corneal stromal inflammation with hypotony and resulting hypotonic maculopathy after 6 weeks after introduction of brimonidine treatment. Systemic work-up for system autoimmune and infectious diseases was negative. We discontinued brimonidine and administered topical prednisolone under which inflammatory corneal signs and intraocular pressure normalized. Chorioretinal folds persisted after 9 months. CONCLUSION: Our case report suggests monitoring patients under brimonidine for sterile corneal infiltration.

Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile / Queratitis infecciosa por Staphylococcus epidermidis resistente a meticilina: perfil clínico y microbiológico

Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. Ahigh percentage of resistance to methicillin is shown, whichgives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical andmicrobiological variables in patients with infectious keratitisdue to SE.Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE,between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions,treatment, evolution) and microbiological (susceptibility toantibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE)infection were compared.Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid.Rates of resistance to tetracyclines and ciprofloxacin were50% and 56% in the MRSE group, and 11% and 7% in theMSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not showstatistically significant differences between groups.Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings (AU)

Introducción. Staphylococcus epidermidis (SE) es unacausa frecuente de queratitis bacteriana en ciertas áreas geográficas. Presenta un alto porcentaje de resistencia a meticilina, lo que confiere resistencia cruzada a beta-lactámicos y enalgunas ocasiones también resistencia a otros grupos de antibacterianos. Analizamos variables clínicas y microbiológicas enpacientes con queratitis infecciosa por SE.Métodos. Se analizaron retrospectivamente las historiasclínicas de 43 pacientes con sospecha de queratitis infecciosa yconfirmación microbiológica para SE, entre octubre de 2017 yoctubre de 2020. Se analizaron las características clínicas (factores de riesgo, tamaño de las lesiones, tratamiento, evolución)y microbiológicas (susceptibilidad a antibióticos) y se compararon grupos de pacientes con infección resistente (MRSE) ysensible a meticilina (MSSE).Resultados. El 37,2% de las queratitis fueron por MRSE.Todos los aislados fueron sensibles a vancomicina y linezolid.Las tasas de resistencia a tetraciclinas y ciprofloxacino fueron50% y 56% en el grupo de MRSE, y 11% y 7% en el grupode MSSE. Las características clínicas, incluido el tamaño de lalesión, la afectación del eje visual, la inflamación de la cámaraanterior, la presencia de factores de riesgo y el tiempo de seguimiento, no mostraron diferencias estadísticamente significativas entre los grupos.Conclusiones. MRSE es una causa frecuente de las queratitis infecciosas producidas por SE y presenta una alta tasade resistencia a múltiples fármacos. Clínicamente, no muestradiferencias clínicas con la queratitis por MSSE. Se necesitantrabajos adicionales para confirmar estos hallazgos. (AU)

Monitoring therapy in anterior necrotizing scleritis with inflammation with anterior segment optical coherence tomography.

INTRODUCTION: Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. METHODS: Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. RESULTS: The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. CONCLUSIONS: Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.

Recommendations for ophthalmologic practice during the easing of COVID-19 control measures.

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th ) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic.

Dual corneal involvement by endothelial and epithelial corneal dystrophies in Steinert's disease: A case of triple dystrophy.

INTRODUCTION: A case of dual corneal involvement due to Fuchs endothelial corneal dystrophy and epithelial basement membrane corneal dystrophy in a patient with Steinert's myotonic dystrophy type 1 is described, and a literature review on the triple association is made. CASE DESCRIPTION: A 52-year-old male diagnosed with myotonic dystrophy type 1 presented due to progressive bilateral vision loss during the past year. A full ophthalmological evaluation was made, with biomicroscopy, funduscopy, anterior segment optical coherence tomography, and endothelial cell count using specular microscopy. Exploration revealed bilateral superior palpebral ptosis, visual acuity 0.5 in the right eye and 0.3 in the left eye, and with an intraocular pressure of 11 and 10 mmHg, respectively. Biomicroscopy revealed map-dot-fingerprint lesions characteristic of epithelial basement membrane corneal dystrophy in both eyes, as well as abundant endothelial guttae due to Fuchs endothelial corneal dystrophy (stage II) and bilateral nuclear and posterior subcapsular cataracts. Specular microscopy in turn showed cell loss and a destructured endothelial map. Finally, anterior segment optical coherence tomography revealed the accumulation of epithelial basement membrane and hyperreflective endothelial excrescences corresponding to guttae. CONCLUSION: The association of Fuchs endothelial corneal dystrophy with myotonic dystrophy has been described and explained by a common genetic basis in the expansion of a CTG trinucleotide repeat, though this is the first reported case of the triple association of Fuchs endothelial corneal dystrophy, epithelial basement membrane corneal dystrophy, and myotonic dystrophy type 1. New mutations or still unknown genetic alterations could possibly explain the triple association reported in our case.

Retinal detachment with spontaneous dialysis of the ora serrata in a 13-year-old child with neurofibromatosis type 1: A case report.

A 13-year-old child diagnosed with neurofibromatosis type 1 who on a routine control presented with rhegmatogenous retinal detachment associated to dialysis of the ora serrata in the left eye (OS). There were no clinical signs or history of contuse ocular trauma. Neurofibromatosis produces alterations in fibroblasts of the cortex of the vitreous base. This results in deficient production of the collagen fibers that anchor the vitreous base to the pars plana and the peripheral neurosensory retina. Thus, suboptimal function of the fibroblasts explains spontaneous avulsion of the vitreous base. Such avulsion in turn is related to dialysis of the ora serrata.

Retinopatía tipo Purtscher en fallo renal por glomerulonefritis aguda postestreptocóccica. Estudio evolutivo con Tomografía de Coherencia Óptica (TCO) / Purtscher-like retinopathy in renal failure caused by acute post-streptococcal glomerulonephritis. Optical Coherence Tomography (OCT) study

Introducción: la retinopatía tipo Purtscher es una complicación asociada a varias enfermedades. En muchos casos el tratamiento de la enfermedad de base es suficiente para la resolución de la retinopatía. Objetivo: reporte de caso que sugiere la validez de la OCT para el estudio de la retinopatía tipo Purtscher. Diseño del estudio: reporte de caso. Resumen del caso: hombre de 36 años presentó una retinopatía tipo Purtscher asociada a glomerulonefritis aguda postestreptocóccica. La mejor agudeza visual corregida (MAVC) era de contar dedos en ambos ojos (AO). La funduscopia reveló manchas algodonosas, hemorragias intrarretinianas y retinianas superficiales. La tomografía de coherencia óptica (OCT) mostró edema macular en AO. Realizamos el seguimiento el primer y tercer mes tras la presentación inicial hasta la resolución de la retinopatía sin tratamiento oftalmológico. Conclusión: la OCT es un método no invasivo útil en el estudio de la retinopatía tipo Purtscher.

Background: Purtscher-like retinopathy is a complication associated with several diseases. In many cases the treatment of the underlying desease is sufficient for the resolution of retinopathy. Objective: to report a case and suggest the use of optical coherence tomography (OCT) for the study of Purtscher-like retinopathy. Study design: a case report Case summary: a 36-year-old man presented a Purtscher-like retinopathy associated with acute post-streptococcal glomerulonephritis. The best corrected visual acuity (BCVA) was to count fingers in both eyes (OU). Funduscopy revealed cotton spots, intraretinal hemorrhages and superficial retinal hemorrhages. Optical coherence tomography (OCT) showed macular edema in OU. We monitored the first and third month after the initial presentation until the resolution of retinopathy without ophthalmological treatment. Conclusion: OCT is a non-invasive method useful in the study of Purtscherlike retinopathy.

Primary multifocal anaplastic large cell lymphoma with eyelid involvement: a case report / Linfoma anaplásico de grandes células primário multifocal com envolvimento de pálpebra: relato de caso

ABSTRACT Ocular adnexal involvement in CD30+ lymphoproliferative disorders is rare. We report the case of a 73-year-old woman with a relapsing primary cutaneous anaplastic large cell lymphoma on her eyelid. A systemic extension study excluded extracutaneous involvement. Systemic chemotherapy resulted in an optimal response, with complete regression of the cutaneous lesions. There has been no recurrence during the 2 years of follow-up.

RESUMO O acometimento ocular adicional nos distúrbios linfoproliferativos CD30+ é raro. Relatamos o caso de uma mulher de 73 anos com linfoma de grandes células anaplásicas primárias recidivantes em sua pálpebra. A avaliação sistêmica excluiu envolvimento extracutâneo. A quimioterapia sistémica resultou em uma resposta ótima, com regressão completa das lesões cutáneas. Não houve recidiva durante 2 anos de acompanhamento.

Primary multifocal anaplastic large cell lymphoma with eyelid involvement: a case report.

Ocular adnexal involvement in CD30+ lymphoproliferative disorders is rare. We report the case of a 73-year-old woman with a relapsing primary cutaneous anaplastic large cell lymphoma on her eyelid. A systemic extension study excluded extracutaneous involvement. Systemic chemotherapy resulted in an optimal response, with complete regression of the cutaneous lesions. There has been no recurrence during the 2 years of follow-up.

Purtscher's retinopathy case report: short posterior ciliary arteries contribution to radial peripapillary capillary system observed with optical coherence tomography angiography.

PURPOSE: The authors report a case of Purtscher's retinopathy whose optical coherence tomography angiography (OCT-A) analysis allows us to better understand the vascular network of the optic disk. METHODS: Case report. RESULTS: A 75-year-old man presented with vision loss in his left eye (LE) after chest compression. The best-corrected visual acuity (BCVA) in the LE was 20/200, and the anterior segment showed a relative afferent pupillary defect. Dilated fundus examination revealed white peripapillary retinal patches and macular hemorrhage. The OCT scan showed edema and hyper-reflectivity of the inner retinal layers at macular level. In turn, OCTA evidenced capillary dropout in both macular retinal plexus, though with preservation of the radial peripapillary capillaries (RPC) and choriocapillary layer. At 9 months, BCVA was 20/20 associated with persistence macular ischemia but unaffected RPC. CONCLUSION: In conclusion, this case suggests that the RPC does not depend exclusively on retinal capillaries as there was a reversible damage after a microvascular retinal disorder such as Purtscher's retinopathy. Possibly, the contribution from short posterior ciliary arteries ensures proper vascularization as choriocapillary layer also remained unaffected. Furthermore, OCTA is considered a useful tool that affords better assessment of RPC than FA.

Intracrystalline Ozurdex®: therapeutic effect maintained for 18 months.

INTRODUCTION: Ozurdex® is a sterile, sustained-release implant of dexamethasone. The device dissolves within the vitreous body and releases dexamethasone. Here we present a clinical case that demonstrates the sustained therapeutic efficacy of Ozurdex® when accidentally injected into the crystalline lens. METHODS: Case report. RESULTS: Sixty-three-year-old male in which we decided to prescribe the intravitreal injection of a dexamethasone implant (Ozurdex®) in the left eye because of macular oedema after branch retinal vein occlusion. Best-corrected visual acuity (BCVA) was 0.4. At 15 days post-implantation, the slit-lamp examination revealed the dexamethasone implant was located in the crystalline lens. Given there was no inflammation in the anterior pole, no cataracts had developed, the intraocular pressure (IOP) was normal and the macular oedema had been resolved, we decided to assess the efficacy and safety of the dexamethasone implant located in the crystalline lens. The BCVA improved until 14 months post-accidental injection. At 18 months post-Ozurdex® injection the BCVA worsened until 0.05 because of the cataract evolution. Phacoemulsification and intraocular lens placement in sulcus was performed. CONCLUSION: Once the complication has occurred, most authors advocate the early withdrawal of the implanted Ozurdex® device by means of crystalline phacoemulsification and then repositioning it in the vitreous body. However, as long as there are no signs of inflammation in the anterior pole, the IOP is within normal limits, the device does not affect the visual axis and there is no cataract development, we can evaluate the potential therapeutic effect of Ozurdex® in this non-indicated, abnormal location.

ACUTE VISION LOSS AS THE ONLY SIGN OF LEUKEMIA RELAPSE.

PURPOSE: To report a case of unilateral exudative retinal detachment as the sole presentation of relapsing B-type lymphoblastic leukemia in a 35-year-old man after 3 years of remission. METHODS: Case report. RESULTS: A 35-year-old man in complete remission of high-risk type B acute lymphoblastic leukemia (ALL-B) presented with acute vision loss in his left eye. Exudative retinal detachment was diagnosed at initial evaluation. Hematological and ocular studies were performed. Although there was no evidence of blood, cerebrospinal fluid, or bone marrow disease relapse, transvitreal retinochoroidal cytology identified the infiltration of lymphoblastic leukemic B cells with t(12:21) translocation as the only sign of relapsing ALL-B. CONCLUSION: At first sign of vision loss or ocular symptoms in a patient with a history of lymphoblastic leukemia, and regardless of the hematological findings, exhaustive ophthalmologic exploration and ocular biopsy should be performed without delay-this being crucial for clinical decision making because a prompt diagnosis improves the chances of survival.

Correlation Between Ischemic Retinal Accidents and Radial Peripapillary Capillaries in the Optic Nerve Using Optical Coherence Tomographic Angiography: Observations in 6 Patients.

BACKGROUND: Perfusion of the optic nerve has been widely studied using fluorescein angiography (FAG), which is currently regarded as the criterion standard. However, FAG has adverse effects associated with intravenous contrast administration and is limited in its capacity to characterize and stratify the different vascular layers of the optic nerve and retina. The use of new imaging techniques, such as optical coherence tomographic angiography (Angio-OCT), is therefore important. AIM: A qualitative description is made of the vascular layers of the optic nerve and of how vascular events affect radial peripapillary capillaries (RPC). Two patients with central retinal artery occlusion (CRAO), 1 with arteritic anterior ischemic optic neuropathy (AAION), and 3 healthy subjects were studied. RESULTS: The Angio-OCT imaging afforded better visualization of the depth of the RPC and rest of the vascular layers of the retina compared with FAG. Optic nerve surface perfusion was affected in AAION and proved normal in CRAO. CONCLUSIONS: Our results indicate that perfusion of the papilla and RPC mainly arises from the papillary plexus that depends on the posterior ciliary artery.

Glistenings in the Artiflex phakic intraocular lens.

PURPOSE: To report the appearance of glistenings in the Artiflex iris-claw phakic intraocular lens (pIOL) (Ophtec B.V.); evaluate their prevalence, severity, and visual significance; and determine whether a large in-depth study of the IOL is warranted. SETTING: La Fe University Hospital, Valencia, Spain. METHODS: Twenty eyes of 13 patients who had the Artiflex pIOL implantation at the same institution over a 2-year period were randomly selected and evaluated by slitlamp examination; visual acuity was also measured. Glistenings in the Artiflex pIOL were graded from trace to 4+ at the slitlamp. RESULTS: Four Artiflex pIOLs had lenticular glistenings ranging from grade 1+ to grade 4+. Analysis of visual acuity and patient satisfaction showed that the glistenings had no clinical significance. CONCLUSIONS: Glistenings appeared some Artiflex pIOLs to varying degrees, although they were not visually significant in any case. A larger study of this IOL is needed to determine whether severe cases of glistenings affect visual function and assess their cause and evolution over time.

Anterior chamber infiltration in a patient with Ph+ acute lymphoblastic leukemia in remission with imatinib.

PURPOSE: Anterior chamber involvement is unusual in patients with acute lymphoblastic leukemia (ALL) and has never been described in the setting of Ph+ (Philadelphia chromosome-positive) ALL. Moreover, there have been no reports of this complication as a primary relapse in a patient treated with imatinib. DESIGN: Interventional case report. METHODS: A 55-year-old woman with Ph+ ALL in complete remission with imatinib and presenting unilateral anterior uveitis at initial examination was clinically evaluated. Hematologic and ocular studies were performed: blood films, bone marrow smears, and anterior chamber paracentesis with aqueous fluid cytology. RESULTS: Although there was no evidence of leukemia in the blood or bone marrow samples, aqueous fluid cytology identified Ph+ positive lymphoblastic leukemic cells. CONCLUSIONS: The patient had developed anterior chamber infiltration without hematological relapse while treated with imatinib. In our opinion, paracentesis should be performed without delay when uveitis develops in ALL, regardless of systemic relapse.