SURGICAL TREATMENT OF VITREORETINAL COMPLICATIONS DURING DISSEMINATED INTRAVASCULAR COAGULATION SECONDARY TO MENINGOCOCCEMIA.

PURPOSE: To report a case of the surgical management of vitreoretinal complications during disseminated intravascular coagulation secondary to meningococcemia. METHODS: A case report. RESULTS: A 25-year-old man presented with loss of vision due to retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia. Examination revealed the visual acuity to be counting fingers in the right eye and light perception in the left eye. Bilateral vitreous hemorrhages were found on fundus examination. A dome-shaped lesion overlying the macula consistent with a subinternal limiting membrane hemorrhage was seen on optical coherence tomography. Bilateral vitrectomy was performed. Multiple subinternal limiting membrane hemorrhages were evident in the posterior pole. A membrane forceps was used to peel the internal limiting membrane and remove the fibrin under it. The internal limiting membrane and vitreous samples were sent for anatomopathological examination confirming our hypothesis. The peripheral retina revealed bilateral multiple ischemic areas, and argon laser photocoagulation was performed on it. Both eyes were filled with silicone oil. Eight months after surgery, his vision improved to 70 and 65 on the early diabetic retinopathy study scale in the right and left eyes, respectively. CONCLUSION: Published cases of retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia are few. There is no specific and codified management of these ocular complications. This case is the first reporting positive visual recovery after surgical treatment. Surgical procedure seems to be effective to treat multiple vitreoretinal hemorrhages secondary to meningococcemia.

Syphilitic Scleritis.

A 47-year-old man developed a painful right red eye for 72 hours with a 20/25 decreased visual acuity. He had no medical history. Slit-lamp examination revealed a painful nodular scleritis at the equator of the globe in the infero-temporal quadrant. There was a moderate intraocular inflammation in the anterior segment. Fundus examination revealed a grade 1 hyalitis and a focal retinitis with vasculitis and arterio-veinous occlusion toward the scleritis zone. Syphilis and HIV serology were positive and the scleritis resolved 5 days after a penicillin G medication. Syphilitic scleritis are relatively uncommon.

Central PresbyLASIK for Hyperopia and Presbyopia Using Micro-monovision With the Technolas 217P Platform and SUPRACOR Algorithm.

PURPOSE: To analyze the refractive outcomes and satisfaction of presbyopic hyperopes treated with central presbyopicLASIK (presbyLASIK) with induced micro-monovision. METHODS: This retrospective study included 74 eyes of 37 patients treated with central presbyLASIK with micro-monovision using the Technolas 217P excimer laser (Technolas Perfect Vision GmbH, Munich, Germany) between June 2011 and March 2014. Study parameters included uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA), aberrometry, the central steep zone, and patient satisfaction. RESULTS: Median age was 54.3±4 years (range: 46 to 63 years). Mean postoperative spherical equivalent refraction was 0.00±0.58 diopters (D) for dominant eyes and -0.51±0.54 D for non-dominant eyes. Mean binocular UDVA was 0.01±0.10 logMAR (Snellen 20/20) at 6 months and -0.01±0.05 logMAR (Snellen 20/19) at 1 year postoperatively. Mean binocular UNVA was 0.18±0.14 logMAR (Parinaud 2) (Jaeger 1) at 6 months and 0.18±0.12 logMAR (Parinaud 2) (Jaeger 1) at 1 year postoperatively. At 6 months, 79.31% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. At 1 year, 84.21% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. The mean central steep zone was 2.35±1.00 D. There were significantly more negative spherical aberration and vertical coma in the central 5 mm postoperatively (P<.05). The re-treatment rate was 6.75%. Eighty-three percent of these patients did not need any glasses for distance and near vision. CONCLUSIONS: This procedure may improve functional near, intermediate, and distance vision in presbyopic patients with low and moderate hyperopia.

Scene perception in age-related macular degeneration.

PURPOSE: To assess the scene gist recognition in eyes with age-related macular degeneration (AMD) and to study the relationship between scene recognition and macular function. METHODS: Twenty-seven patients with age-related macular degeneration with a visual acuity lower than 20/50 and 17 age-matched controls were included. All patients underwent a visual field test, fundus autofluorescence, and fluorescein angiography to assess the visual field defect and the lesion size. The stimuli were colored photographs of natural scenes displayed on a 30-inch screen. Two scene categorization tasks were performed: natural versus urban and indoor versus outdoor scenes. Participants were given a target (e.g., indoor scenes) and asked to press a key when they saw a picture corresponding to that target. Accuracy and response times were recorded. RESULTS: Patients with AMD were able to accomplish both categorization tasks with a high correct detection rate (above 75% correct), though performance was lower than in controls for both natural/urban scenes and indoor/outdoor scenes. Patients with AMD were more accurate and faster for natural/urban scenes than for indoor/outdoor scenes, but performance did not differ between the two categories in controls. No significant correlation was found between performance for scene categorization and clinical variables such as visual acuity, type of AMD, size of the scotoma, and size of the lesion. CONCLUSIONS: Scene gist recognition can be accomplished with the low spatial resolution of peripheral vision. These results support the "scene-centered approach" that initial scene recognition is based on the global scene properties and not on the objects it contains.