Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia.

BACKGROUND: Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. METHODS: We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. DISCUSSION: The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. TRIAL REGISTRATION: This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.

Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies.

Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectral-domain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups (P = 0.18). However, mean MP overall sensitivity was significantly higher in group A (29.05 ± 0.57 dB versus group B, 26.05 ± 2.75 dB; P < 0.001). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated (P < 0.001). Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine.

Hallazgos radiológicos en ecografía y tomografía computada multidetector de 64 canales de una invaginación colo-cólica secundaria a lipoma / Radiological findings on ultrasonography and multidetector computed tomography of 64 channels of a colo-colonic intussusception secondary to lipoma

Si bien la mayoría de los lipomas intestinales son asintomáticos y se diagnostican de manera casual, en algunas ocasiones pueden tener síntomas, como sangrado, diarrea o, con menor frecuencia, obstrucción o invaginación intestinal. Esta última en el adulto es una patología poco común y por lo general tiene una presentación subaguda crónica, cuyo diagnóstico es complicado. La principal técnica de imagen para el diagnóstico de la invaginación intestinal en adultos es la tomografía computada (TC). Solamente un 20% de las invaginaciones son colo-cólicas y en su mayoría son secundarias a un carcinoma. No obstante, en algunas pocas oportunidades pueden ser secundarias a una causa benigna, siendo el lipoma la más usual.

Even though most of the intestinal lipomas are asymptomatic and are diagnosed by chance, sometimes may have symptoms such as bleeding or diarrhea, and less frequently obstruction or intussusception. Intussusception in adults is a rare condition, and usually has a chronic-subacute presentation, and diagnosis is difficult. CT is the main radiological imaging test for diagnosis. Only 20% of the colonic invaginations are colo-colic, and in most cases are secondary to carcinoma. Rarely are secondary to a benign cause, being the intussusception secondary to a lipoma the most frecuent.

Hallazgos radiológicos en ecografía y tomografía computada multidetector de 64 canales de una invaginación colo-cólica secundaria a lipoma

Si bien la mayoría de los lipomas intestinales son asintomáticos y se diagnostican de manera casual, en algunas ocasiones pueden tener síntomas, como sangrado, diarrea o, con menor frecuencia, obstrucción o invaginación intestinal. Esta última en el adulto es una patología poco común y por lo general tiene una presentación subaguda crónica, cuyo diagnóstico es complicado. La principal técnica de imagen para el diagnóstico de la invaginación intestinal en adultos es la tomografía computada (TC). Solamente un 20% de las invaginaciones son colo-cólicas y en su mayoría son secundarias a un carcinoma. No obstante, en algunas pocas oportunidades pueden ser secundarias a una causa benigna, siendo el lipoma la más usual.(AU)

Even though most of the intestinal lipomas are asymptomatic and are diagnosed by chance, sometimes may have symptoms such as bleeding or diarrhea, and less frequently obstruction or intussusception. Intussusception in adults is a rare condition, and usually has a chronic-subacute presentation, and diagnosis is difficult. CT is the main radiological imaging test for diagnosis. Only 20% of the colonic invaginations are colo-colic, and in most cases are secondary to carcinoma. Rarely are secondary to a benign cause, being the intussusception secondary to a lipoma the most frecuent.(AU)