Neovascular glaucoma caused by small-cell lung cancer iris metastasis: A case presentation.

Small-cell lung cancer may directly affect the eye by metastatic proliferation or indirectly by paraneoplastic syndromes. The choroid is the most common site for uveal metastasis (90%); however, the iris can be involved in a smaller proportion of cases (incidence <10%). Blurred vision, pain, redness, photophobia, glaucoma, hyphema and visual field defects can arise from this metastatic involvement. The median survival time for patients with iris metastasis is reported to be 4 months. Secondary glaucoma can be managed with topical and oral treatment, transscleral cyclophotocoagulation, laser trabeculoplasty, anti-VEGF, Minimally Invasive Glaucoma Surgery (MIGS), filtering surgery, shunting surgery or enucleation. A case of primary small-cell lung cancer with iris metastasis is presented. The metastases produced an angle-closure glaucoma, which was refractory to topical treatment. Local radiotherapy was administered, obtaining a good local response.

Ocriplasmin retinopathy: Possible cause of macular hole closure failure. / Retinopatía asociada a ocriplasmina: posible causa de fracaso de cierre de agujero macular.

CASE REPORT: A 53 year-old woman with a stage 2 macular hole received ocriplasmin injection as a first approach. She subsequently underwent pars plana vitrectomy due to enlargement of the hole post-injection. The visual gain following the surgery was minimal despite closure of the hole. This could be explained by outer retina atrophy as a consequence of potential toxic mechanisms related to ocriplasmin. DISCUSSION: Further studies may be warranted to fully understand the impact of ocriplasmin on long-term visual function.

Alternative treatment for retinoblastoma: Intra-arterial chemotherapy with melphalan.

CASE REPORT: A 10-month old infant was referred for the study of a leukocoria of the left eye of one month onset. On examination, a retinoblastoma occupying the macular area was detected. Treatment with intra-arterial chemotherapy (melphalan 6 mg) was performed, with no further intervention required for disease control. DISCUSSION: Melphalan is an effective chemotherapeutic agent. However, its use is limited by the systemic toxicity that may occur. Intra-arterial chemotherapy allows the selective release of melphalan into the ophthalmic artery, thus limiting its systemic toxicity. This combination of efficiency, safety and accuracy makes it an attractive therapeutic alternative for the management of retinoblastoma.

[Autoimmune hepatitis in a patient with serpiginous choroiditis]. / Hepatitis autoinmune en un paciente con coroiditis serpiginosa.

CASE REPORT: We report the case of a patient with serpiginous choroiditis who developed an autoimmune hepatitis. DISCUSSION: The etiology of serpiginous choroiditis remains uncertain. An immune-mediated mechanism has been reported. This case shows an association between serpiginous choroiditis and autoimmune processes.

Ahmed valve for elevated intraocular pressure associated with black diaphragm lenses for aniridia.

PURPOSE: To evaluate the Ahmed valve for decrease elevated pressure associated with black diaphragm lenses for aniridia. METHODS: Drainage devices are useful to obtain good control of intraocular pressure in patients with aniridia and the authors often use them because of the poor results of medical therapy or filtering surgery. However, when the elevated intraocular pressure is associated with black diaphragm lenses for aniridia, most authors decide to carry out a filtering technique. The current authors opted for the implantation of an Ahmed valve in three patients, two with traumatic aniridia and the other with a congenital case. Every patient had a different kind of black diaphragm lens for aniridia. RESULTS: The Ahmed valve controlled the intraocular pressure in levels below 20 mmHg for a follow-up year with no complications derived from its application. CONCLUSIONS: Ahmed valve implantation was the best technique to decrease intraocular pressure in patients with aniridia. The authors have used it successfully for cases with elevated pressure associated with black diaphragm lenses for aniridia.

Implantation of iris devices in congenital and traumatic aniridias: surgery solutions and complications.

PURPOSE: To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up. METHODS: Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months). RESULTS: All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve. CONCLUSIONS: Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.

Posterior chamber phakic intraocular lenses to correct high myopia: a comparative study between Staar and Adatomed models.

PURPOSE: To determine the feasibility of using posterior chamber phakic intraocular lenses (PIOLs) to treat high myopia, comparing two different models, Staar and Adatomed. METHODS: Twenty-four eyes from 12 patients were studied prospectively. A phakic Staar IOL was implanted in one eye of each patient, and the other eye received a phakic Adatomed IOL. Patients with uveitis or ocular trauma prior to ocular surgery, diabetic retinopathy, or capsular pseudoexfoliation were excluded. The mean preoperative spherical equivalent refraction was -16.00 +/- 5.05 D for the Staar group and -15.39 +/- 2.83 D for the Adatomed group. Average follow-up was 32.4 months (range, 19 to 46 mo) for the Adatomed group and 18.3 months (range, 11 to 21 mo) for the Staar group and included evaluation of intraocular pressure, intraocular lens pigment deposits, lens decentration, anterior subcapsular cataract, and visual acuity. RESULTS: Spectacle-corrected and uncorrected visual acuity improved in all eyes in both groups. No statistically significant differences in visual acuity gain were observed with the two materials (Student t-test, P = .08 for the Staar group and P = .6 for the Adatomed group), although the gain in visual acuity was somewhat greater with the Staar PIOLs. The difference in mean intraocular pressure before surgery and at last follow-up was 1.5 mmHg for the Staar group and 2.3 mmHg for the Adatomed group (P = .36). The incidence of lens pigment deposits was the same in both groups (41.66%), with deposits in 5 of the 12 eyes in both groups. The incidence of lens decentration was higher in the Adatomed group (5/12; 41.66%) than in the Staar group (2/12; 16.7%). Anterior subcapsular cataract was higher in the Adatomed group (4/12; 33.3%) than in the Staar group (3/12; 25%). CONCLUSIONS: There was a higher incidence of lens decentration and anterior subcapsular cataract in the Adatomed group than in the Staar group.

[High altitude retinal hemorrhages in the expeditions to 8,000 meter peaks. A study of 10 cases]. / Hemorragias retinianas en las expediciones a montañas de más de 8.000 m. Estudio de 10 casos.

BACKGROUND: Retinal haemorrhages are common at high altitude. Their pathogenesis is unknown. It has been suggested that they are less frequent in sherpas, and that possible predisposing factors might be the abscence of previous high-altitude experience, the extent of the high-altitude hypoxic exposure, polycythemia (because of hyperviscosity), history of cough and Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness (high-altitude pulmonary oedema and high-altitude cerebral oedema) and use of antiinflammatory drugs. The aim of this study is to know the incidence of retinal haemorrhages in the expeditions to mountains higher than 8.000 m and their relationship to the previously referred possible predisposing factors. SUBJECTS AND METHODS: Funduscopy was performed on 17 healthy subjects taking part in expeditions to Cho-Oyu (8.201 m) and to Shisha Pangma (8.046 m) and on six of their Nepali coworkers. RESULTS: Retinal haemorrhages were found in 10 of the European (59%) and in none of the Nepali mountaineers (p = 0.019). Other 2 Spanish climbers had tortuosity and engorgment of the retinal veins. No statistical association was found between retinal haemorrhages and maximal altitude attained prior to the expedition, maximal altitude reached during the present expedition, number of nights spent at extreme altitude, weight loss as an expression of chronic exposure to hypoxia, haemoglobin, history of cough or Valsalva manoeuvres during the expedition, existence of severe forms of mountain sickness or use of drugs. CONCLUSIONS: These results do not allow us to state that the mentioned factors predispose to high-altitude retinal haemorrhages.

Iris claw phakic intraocular lens for high myopia.

BACKGROUND: The implantation of a Worst-Fechner iris claw intraocular lens (IOL) is one of the surgical procedures used for the correction of high myopia. This technique reduces myopia with stable refractive results; however, its potential long-term risks have not been evaluated. We report results in 94 eyes with a minimum follow-up of 3 years. METHODS: We studied 94 eyes of 62 patients with myopia > or = -7.00 diopters (D) who underwent Worst-Fechner IOL implantation. Lens decentration, permeability of the blood-aqueous barrier by iris angiography, and changes in corneal endothelial density were analyzed. RESULTS: Mean follow-up time was 48.9 months (range 36 to 72 mo). Three years after surgery, 58 eyes (61%) had an uncorrected visual acuity > or = 20/40, and 77 eyes (82%) gained two or more lines of spectacle-corrected visual acuity with respect to the preoperative value; 75 eyes (79%) were within +/- 1.00 D of emmetropia and 46 eyes (48%) were within +/- 0.50 D of emmetropia. The mean endothelial cell loss was 17.9% at 5 years after surgery, while the percentage of hexagonality and the coefficient of cell variation tended toward preoperative levels. No vision threatening complications were seen. CONCLUSIONS: The implantation of a Worst-Fechner iris claw phakic IOL reduced high myopia with a stable refractive outcome. Endothelial cell damage was within acceptable limits. The absence of major complications makes this procedure an acceptable method for correcting high myopia.

Reproducibility of digital image analysis for measuring corneal haze after myopic photorefractive keratectomy.

PURPOSE: To evaluate the usefulness of digital image analysis for quantifying corneal haze by determining the reproducibility of its measurements at the corneal plane. METHODS: In a prospective study, 20 randomly selected eyes that had undergone myopic photorefractive keratectomy were photographed focusing the slit beam on their anterior corneal surface. Each photograph was examined using computer image analysis techniques that detect the edge of the reticular pattern of the image. Quantification of the difference between two areas, treated and adjacent untreated cornea, each containing 3,750 pixels with a resolution of 256 gray levels, was performed. Intra-analyzer variation was determined by evaluating the photographs obtained by two analyzers under standard conditions on four separate visits. Interanalyzer variation was calculated using one measurement and the mean of the four measurements. RESULTS: The pooled standard deviation of the measurements for the analyzers was 0.63 and 0.62 gray levels (coefficient of variation, 4.1% and 3.3%). An association between less severe haze measurements and higher reproducibility scores was found (r = .42; P = .007). The mean interanalyzer variation was smaller for the average of four measurements, 0.55 +/- 0.37 gray levels, than for one measurement, 0.94 +/- 0.73 gray levels (P = .014). CONCLUSIONS: Good reproducibility for haze measurements by digital image analysis of the differences between the treated and adjacent untreated corneal areas was obtained. When the average of four measurements was used instead of a single measurement, interanalyzer reproducibility increased significantly. This new technique may be used to quantify and analyze corneal haze after myopic photorefractive keratectomy.

Direct objective quantification of corneal haze after excimer laser photorefractive keratectomy for high myopia.

PURPOSE: The purpose of the study is to measure regional distribution differences in corneal haze after excimer laser photorefractive keratectomy for high myopia. METHODS: The authors developed computerized gradient edge detectors with which were analyzed digitized anterior slit-lamp photographs of 40 eyes, an average of 21.0 plus or minus 14.5 weeks after photorefractive keratectomy for high myopia (-6 to -22 diopters). A treated area an adjacent untreated area on the anterior corneal surface, each containing six regions, were quantified, and the difference was correlated with various parameters. RESULTS: Mean differences between scarred and clear areas for haze grade 0.5, 1.0, 2.0, 3.0, and 4.0 were 16.9, 26.6, 42.6, 60.4, and 76.4 gray levels, respectively (rs = 0.96; P = 0.0001). A low but statistically significant correlation between the intended correction and postoperative corneal haze was found (r = 0.33; P = 0.037). The mean coefficient of variation of the amount of opacification within each treated area was 9.4%. This coefficient of variation increased with a longer follow-up time (r = 0.88; P = 0.0001). The difference in the intensity of haze between the center and more peripheral regions over the entrance pupil did not correlate with the attempted correction. However, a strong association between a relatively less severe central corneal haze with respect to more peripheral haze and longer follow-up time was found (r = -0.96; P = 0.0001). CONCLUSION: The amount of corneal haze showed a weak positive association with the attempted correction in excimer laser photorefractive keratectomy for high myopia. Corneal haze appeared fairly uniformly distributed within the ablation zone, but a more heterogeneous distribution was found with a longer follow-up time. Furthermore, later postoperative examinations disclosed a clear trend toward diminishing central opacification relative to peripheral regions over the entrance pupil.

Excimer laser photorefractive keratectomy for high myopia.

One hundred and thirty-three eyes of 103 patients had photorefractive keratectomy with a slit scan mode excimer laser for myopia ranging from -6.00 to -22.00 diopters (D). The epithelium was removed with 20% ethanol, and the ablation was done with a tapered profile surrounding the optical zone. Patients were divided into two groups based on preoperative myopia: Group A, -6.00 D to -12.00 D (88 eyes); Group B, -12.50 D to -22.00 D (45 eyes). In Group A, mean preoperative refraction was -9.59 +/- 1.79 D. Mean postoperative refraction was -0.29 +/- 1.47 D at one month, -0.85 +/- 1.68 D at three months, -1.17 +/- 2.04 D at six months, and -0.56 +/- 0.74 D at one year. Anterior stromal haze was greatest at the end of the first month; it diminished thereafter. This haze did not reduce the best corrected visual acuity in any eye in Group A. Mean preoperative refraction in Group B was -14.69 +/- 5.27 D. Mean postoperative refraction was -1.34 +/- 2.02 D at one month, -0.76 +/- 2.08 D at three months, -3.88 +/- 2.32 D at six months, and -5.50 +/- 5.00 D at one year. Three eyes in Group B lost one or two lines of best corrected visual acuity as a result of severe stromal haze and epithelial scarring. Group A's results were similar to those obtained in eyes with low myopia.(ABSTRACT TRUNCATED AT 250 WORDS)

Enfermedad de Hansen, córnea y anejos oculares

Examinamos 37 pacientes diagnosticados de lepra estudiando sus alteraciones en anejos y córnea. De ellos eran formas lepromatosas, 2 borderline lepromatosas, 2 borderline tuberculoide y 2 tuberculoides. La mayor parte se encontraban entre la 6ª y 7ª década. En 6 casos no encontramos lesiones de ningún tipo. En los restantes observamos una disminución de la agudeza visual directemante relacionada con la duración de la enfermedad. el hallazgo más frecuente fue la madarosis supraciliar, seguido de la falta parcial de pestañas y madarosis. Debilidad del orbicular y/o lagoftalmos encontramos en 6 casos. La opacidades debidas a queratopatías leprosas típicas, queratopatía "en banda", por oxposición pannus y lepromas corneales, fueron los hallazgos corneales más frecuentes. La presencia de neovascularización fue detectada en 5 pacientes. Concluimos destacando la importancia del estudio de la lepra en oftalmología.

Enfermedad de Hansen, uvea, esclera y retina

Examinamos 37 pacientes diagnosticados de lepra estudiando sus lesiones uveales cristalinas y esclerales. De ellos 31 eran formas lepromatosas, 2 borderline lepromatosas , 2 borderline tuberculoide y 2 tuberculoides. En 6 casos no encontramos lesiones de ningún tipo. En los restantes casos observamos una disminución de la agudeza visual directamente relacionada con la duración de la enfermedad. Las uveites crónicas indolentes fueron la causa más importante de ceguera, de las mismas fueron signos típicos la atrofia iridiana peripupilar, los precipitados queráticos, las sinequias posteriores y la miosis. Un número sorprendentemente elevado de pacientes presentaban ptisis bulbi uni o bilateral por atrofia del cuerpo ciliar. Las lesiones esclerales estuvieron representadas por escleritis, episcleritis en los casos agudos. La ectasia y adelgazamiento escleral aparecieron como secuelas de la anteriores en menor número de pacientes. No hemos encontrado lesiones funduscópicas.

[Angiography by the oral route using enteric-coated capsules]. / Angiographie par voie orale avec des capsules entériques.

We have performed Retinal Fluorescein Angiograms in three groups of patients who had been previously administered, respectively: intravenous sodium fluorescein, hard gelatin-coated fluorescein oral capsules, and enteric-coated fluorescein capsules. In all groups, we carried out a curve of the dye plasma levels. We concluded that the enteric-coated fluorescein capsules provide effective dye plasma levels for the performance of the angiogram between 40 and 60 minutes later, thus obtaining great sharpness and quality retinal images, much better than those attained with the hard gelatin-coated fluorescein capsules.

Tuberculous panophthalmitis associated with drug abuse.

Tuberculous endophthalmitis is a rare condition not described to date in association with intravenous drug abuse. Characteristics such as the lack of proven tuberculous disease in other organs and intense progression towards panophthalmitis make this case all the more interesting. The histopathological diagnosis is based on the identification of acid-alcohol resistant bacilli, and typical granuloma lesions with focal caseosis in stained sections.