How a pediatric neuro-oncology unit was managed in Madrid during the first wave of the COVID-19 pandemic.

INTRODUCTION: During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, infection prevention measures were enforced at our Pediatric Neuro-Oncology unit. METHODS: A retrospective study analyzing patients booked in this unit during lockdown was performed to describe its performance. RESULTS: There were 438 consultations for 123 patients (320 on-site/118 telephone). Eight new diagnoses were made, with one significant delay. Only one patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Delay in imaging testing occurred in 15 patients. Chemotherapy was delayed in one case. There were no delays in radiotherapy. CONCLUSIONS: Measures implemented were effective in minimizing the risk of COVID-19 infection, achieving continuity in diagnoses and treatment, and avoiding delays that could impact survival.

Femtosecond laser-assisted intrastromal corneal ring segment implantation for high astigmatism correction after penetrating keratoplasty.

PURPOSE: To assess the visual and refractive outcomes of femtosecond laser-assisted implantation of Ferrara-type intrastromal corneal ring segments (ICRS) in post-penetrating keratoplasty (PKP) eyes. SETTING: Instituto Oftalmológico Fernández-Vega, Oviedo, Spain. DESIGN: Cohort study. METHODS: Patients with previous PKP had ICRS implantation after femtosecond laser tunnel creation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors were recorded before and 6 months after ICRS implantation. The power vector method was used to analyze refractive errors preoperatively and postoperatively. RESULTS: This study enrolled 32 eyes of 30 patients. The mean UDVA (Snellen decimal) changed from 0.16 ± 0.15 (SD) preoperatively to 0.43 ± 0.28 postoperatively (P<.0001). Postoperatively, the UDVA was 20/40 or better in 40.6% of eyes. The mean CDVA was 0.67 ± 0.22 preoperatively and 0.80 ± 0.19 postoperatively (P<.0001). Postoperatively, the CDVA was better than 20/40 in 96.9% of eyes and 20/25 or better in 56.2% of eyes. By 6 months postoperatively, no eye had lost more than 2 lines of CDVA, 4 eyes lost 1 line, 6 eyes had no change, 9 eyes gained 1 line, and 13 eyes gained 2 or more lines. The safety index at 6 months was 1.20. The spherical equivalent and astigmatism components were significantly reduced after ICRS implantation (P<.04). CONCLUSION: Intrastromal corneal ring segment implantation using the femtosecond laser may be a good alternative for high astigmatism correction in post-PKP eyes.

Unilateral recurrent macular hole in a patient with retinitis pigmentosa: a case report.

INTRODUCTION: Several macular complications related to abnormalities of the vitreoretinal interface have been classically attributed to retinitis pigmentosa of which cystoid macular edema is the most common. Other less frequent complications are as follows: epiretinal membranes, vitreomacular traction syndrome and macular holes. CASE PRESENTATION: A 64-year-old woman, with the previous diagnosis of retinitis pigmentosa, was referred to our department with a complaint of central visual loss in her left eye for 12 months. A fundoscopy and optical coherence tomography examination revealed the presence of a macular hole more than 500 microns in diameter. The patient underwent 20-gauge pars plana vitrectomy. Closure of the hole was observed after surgery, but reopening occurred at 2 years postoperatively. CONCLUSION: The pathogenesis of macular hole formation in patients with retinitis pigmentosa is unclear. Surgical outcomes may not always be favorable, and the possibility of reopening must be taken into account, even after a long time.

Vitreoretinal surgery for bilateral macular holes after laser-assisted in situ keratomileusis for the correction of myopia: a case report.

INTRODUCTION: Laser-assisted in situ keratomileusis surgery may induce postoperative changes in the vitreomacular interface due to the mechanical stretch of the vitreous produced by the suction ring and the shock waves generated by the excimer laser and, subsequently, may provoke macular hole formation. CASE PRESENTATION: A 53-year-old Spanish woman who had undergone a laser-assisted in situ keratomileusis for the correction of myopia in her right and left eye (10 years ago) was referred to our department with a complaint of decreased visual acuity in both eyes. A fundoscopy and optical coherence tomography examination revealed a bilateral full-thickness macular hole. A 23-gauge sutureless pars plana vitrectomy was performed in both eyes, and 1 month after surgery her visual acuity improved and the hole closed. CONCLUSION: The development of a bilateral full-thickness macular hole after laser-assisted in situ keratomileusis has been reported once. This case study enhances our understanding of the vitreoretinal pathology induced by laser-assisted in situ keratomileusis, showing the importance of a rigorous follow-up, because complications may occur even a decade later. In this case study we must also consider the contribution of the underlying myopia to the development of the bilateral macular holes.

Long-term evolution of Valsalva retinopathy: a case series.

INTRODUCTION: Valsalva retinopathy may occur as a sudden, dramatic loss of central vision due to the premacular location of the haemorrhage. It has been described in different clinical settings, and there are several options for its treatment. CASE PRESENTATIONS: We present the cases of six patients with sudden visual acuity loss caused by Valsalva retinopathy, treated in our hospital in the last ten years. Case 1 involves a 32-year-old Caucasian man with a unilateral premacular haemorrhage after vomiting. A neodymium-doped yttrium aluminium garnet laser was used due to sufficient depth of the haemorrhage pocket, but it was unsuccessful. Instead, 20G pars plana vitrectomy was performed with excellent visual recuperation (visual acuity:1.0). Case 2 was of a 36-year-old Caucasian woman with Valsalva retinopathy after vomiting during pregnancy. A neodymium-doped yttrium aluminium garnet laser was also insufficient due to the coagulated blood. After labour, 23G pars plana vitrectomy was performed, and her final visual acuity was 1.0. Case 3 involved a 52-year-old Caucasian man with premacular bleeding due to vomiting after general anaesthesia. The haemorrhage did not resolve spontaneously, so 23G pars plana vitrectomy was performed, with excellent visual outcomes (visual acuity:1.0). Case 4 was a 24-year-old Caucasian man with a macular haemorrhage after thoracic trauma. He was observed over four weeks, after which we performed 23G pars plana vitrectomy, with complete visual restoration (visual acuity:1.0). Case 5 involved a 28-year-old man who developed a premacular bleed after vigorous dancing. After a period of observation, 23G pars plana vitrectomy was performed. A retinal break with a small haemorrhage around the break occurred, related to the peribulbar anaesthesia manoeuvers, but was resolved successfully. His final visual acuity was 1.0. Case 6 was a 22-year-old Caucasian woman who developed a premacular haemorrhage after weightlifting. Conservative management was performed due to the small size of her haemorrhage. It resolved spontaneously within one month, and her final visual acuity was 1.0. CONCLUSION: Valsalva retinopathy is a rare condition that causes a sudden loss of visual acuity. In patients with too dense haemorrhage, the best option could be the vitrectomy, with excellent visual outcomes, although surgery is not free of risks.

Long-term evolution of idiopathic lamellar macular holes and macular pseudoholes.

OBJECTIVE: To analyze the natural evolution of idiopathic lamellar macular holes (LMH) and macular pseudoholes (MPH) in the long term, based on optical coherence tomography (OCT) configuration and on best corrected visual acuity (BCVA) evolution. DESIGN: A prospective, longitudinal study. PARTICIPANTS: We prospectively analyzed 108 eyes (67 left eyes and 41 right eyes) of 99 patients (55 female and 44 male) whose eyes had been diagnosed as having an MPH or an LMH on OCT examination. METHODS: The following variables were assessed: BCVA; lens status; and hole size (diameter, residual foveal thickness, and perifoveal thickness) at baseline and at final examination. RESULTS: The mean follow-up period was 31.07 ± 18.77 (12 to 84) months. The mean BCVA (logMAR) in the total group at baseline was 0.31 ± 0.25, and at final examination it was 0.22 ± 0.21 (p = 0.200). Moreover, we did not observe statistically significant differences regarding diameter, residual foveal thickness, or perifoveal thickness (p = 0.325). CONCLUSIONS: Most idiopathic LMH and MPH do not progress anatomically and do not contribute to a significant diminution in visual acuity during the follow-up period.

Spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole: a case report.

INTRODUCTION: Spontaneous closure of traumatic macular holes is described as a common event in the peer-reviewed literature. However, the spontaneous closure of stage III and IV full-thickness idiopathic macular holes has been reported in less than 15 cases in the literature, this being an extremely rare event, with their reopening being even more infrequent. We report a case of a spontaneous closure of stage IV idiopathic full-thickness macular hole and late reopening as a lamellar macular hole. CASE PRESENTATION: A 67-year-old Spanish man was referred to our hospital with a complaint of decreased vision in his right eye and metamorphopsia for approximately 11 months. He did not report any trauma. Diagnosis was based on fundoscopic and optical coherence tomography. They revealed a stage IV full-thickness idiopathic macular hole and a small epiretinal membrane. Three months later the hole spontaneously closed, and two years later we appreciated its reopening as a lamellar macular hole. CONCLUSIONS: The contraction of the epiretinal membrane could have contributed to cystic spaces and their fusion, subsequently, to the formation of a lamellar macular hole. To the best of our knowledge this is the first report in the literature of a spontaneously closed full-thickness idiopathic macular hole with reopening as a partial thickness macular defect.