[Primary stromal cyst of the iris: case report].

Primary stromal cysts of the iris are rare, often asymptomatic, and incidentally found entities. Treatment is usually indicated in cases of enlargement or complications. However, imaging tests are required to determine their cystic nature and make an accurate differential diagnosis with malignant tumors, as well as for long-term follow-up. Ultrasound biomicroscopy is the technique of choice, although in most centers anterior segment optical coherence tomography is a more accessible and available imaging modality. We present a case of primary stromal cyst of the iris with an atypical presentation to illustrate the diagnosis and initial follow-up using anterior segment optical coherence tomography and photographs, and the management of complications. Anterior segment optical coherence tomography may be useful in the initial study and follow-up of anterior non-pigmented lesions where the cyst can be fully seen.

Influence of ocular biometric factors on the defocus curve in an enlarged depth-of-focus intraocular lens.

BACKGROUND: To assess the influence of biometric measurements on the defocus curve after the implantation of enlarged depth-of-focus (EDoF) intraocular lens (IOL). METHODS: Patients who underwent cataract surgery with bilateral implantation of Tecnis Symfony IOL were enrolled. Preoperatively, axial length (AL), corneal keratometry (K), pupil size and corneal aberrations were measured. 1 month after surgery, distance, intermediate, and near visual acuities (VA) were recorded. At 3 months, monocular and binocular corrected contrast sensitivities under photopic and mesopic lighting conditions were measured with CSV-1000E test. At 6-months, the defocus curve between -5.00 to + 3.00 diopters (D) was assessed in steps of 0.50 D, and NEI-RQL-42 questionnaire was administered. RESULTS: One hundred thirty one eyes of 66 patients were included. Binocular logMAR VA better than 0.1 for intermediate vision was obtained in 90% of patients, whereas only 17.7% obtained that result in near vision. The rate of satisfaction was high (96%) and most of them (85.5%) had no or little difficulties in near vision. The mean amplitude of the defocus curve was 2.35D ± 0.73D, and smaller AL, smaller pupils, younger age, and male sex were associated with wider range of clear vision. CONCLUSIONS: Tecnis Symfony IOL enables functional vision at all distances, but demographic variables and preoperative biometric measurements like AL and pupil size influence the postoperative amplitude of the defocus curve. These parameters could be used to predict the performance of EDoF IOLs.

Tocilizumab resolves refractory macular edema associated to retinitis pigmentosa.

PURPOSE: The aim of this report is to describe the resolution of refractory cystoid macular edema (CME) associated to retinitis pigmentosa (RP) with intravenous tocilizumab in three patients. METHODS: Retrospective study of a series of consecutive cases of patients treated with off-label intravenous tocilizumab (anti IL6) for CME refractory to acetazolamide 250 mg for 3 months. Patients were diagnosed with RP by fundus appearance, electrophysiology, visual fields, and genetic testing. A complete ophthalmic examination, including spectral domain optical coherence tomography (SD-OCT) was performed. PATIENTS: Three patients with RP and CME refractory to acetazolamide 250 mg for 3 months were treated with monthly intravenous tocilizumab for at least six months. RESULTS: All patients resolved CME and improved visual acuity after the third month of intravenous tocilizumab, resolving systemic and ocular adverse events related to previous treatments for CME. Tocilizumab was well tolerated with no other adverse events. DISCUSSION: CME causes visual impairment in RP, but current treatments are usually deficient. Tocilizumab has been successfully used as treatment for refractory CME in uveitis, retinal dystrophies, and autoimmune retinopathies. This article reports, for the first time, the long-term resolution of refractory CME in RP with intravenous tocilizumab.

Comparison of posterior capsule opacification between Clareon CNA0T0 and Tecnis ZCB00 intraocular lenses.

INTRODUCTION: The purpose is to compare posterior capsule opacification (PCO) and its impact on vision between Clareon CNA0T0 (Alcon) and Tecnis ZCB00 intraocular lenses (IOLs) (Johnson&Johnson) 1, 6, and 12 months after implantation. METHODS: A prospective observational study was performed at the Nuestra Señora de Gracia Hospital (Zaragoza, Spain). Fifty eyes (50 patients) with Tecnis IOL (group 1) and 60 eyes (60 patients) with Clareon IOL (group 2) were enrolled. One, 6, and 12 months after age-related cataract surgery by five different surgeons, the following tests were performed: mesopic corrected distance visual acuity (CDVA), CSV1000-E test, KR-1W wavefront analyzer, OQAS II, Catquest-9SF questionnaire and mydriatic slit-lamp pictures. PCO intensity was quantified and the area of opacification was measured using ImageJ (NIH). RESULTS: Mean age was 71.20 ± 6.79 years in group 1, and 71.73 ± 8.17 years in group 2 (p = 0.72); mean axial length was 23.46 ± 1.14 and 23.53 ± 0.91 mm, respectively (p = 0.72); mean IOL power was 21.69 ± 2.26 D and 21.28 ± 2.44 D, respectively (p = 0.37). One month after surgery there were differences in intensity of PCO (0.73 ± 0.60 and 1.05 ± 0.71, respectively, p = 0.02). Six months after surgery statistical differences were found in VA with 20% CS in mydriatic conditions (0.26 ± 0.21 logMAR (20/36) and 0.18 ± 0.17 logMAR (20/30), respectively, p = 0.04). Twelve months after surgery, no differences were detected between groups. As for the evolution of PCO within the Clareon group, high order aberrations (p < 0.05) and the Strehl ratio (p = 0.02) decreased. CONCLUSION: There are no differences in slit-lamp pictures or visual function between both IOLs during the first 12 months after implantation.

Diagnosis and long-term monitoring of adenomas of the ciliary body epithelium by ultrasound biomicroscopy.

INTRODUCTION: The natural course of adenomas of the ciliary-body epithelium (ACE) is uncertain, due to their low incidence and their frequent initial surgical management.Their differential diagnosis with amelanotic melanoma or metastasis is challenging and diagnostic biopsies require sufficient tissue and highly specialized pathologists. Ultrasound biomicroscopy offers high resolution images and clear sonographic signs suggestive of ACE allowing a more precise differential diagnosis and therefore, a more conservative initial attitude. METHODS: Descriptive, retrospective, non-comparative study of consecutive cases of ACE observed between October 2003 and December 2019 in a reference unit in ocular oncology of a tertiary hospital. Patients were studied on a quarterly basis the first year and, subsequently, every 6 months with a complete ophthalmological exam and ultrasound biomicroscopy with the platform Aviso linear scanning 50 MHz probe (Quantel Medical, Clermont-Ferrand, France). RESULTS: Three ACE were analysed for a median of 3 years (interquartile range: 2.5-5.5 years). Clinical features include a whitish-to-brown spherical mass, with engorged superficial vessels. Ultrasound biomicroscopy shows an oval-spherical shape, medium-to-high echogenicity, low acoustic attenuation, regular internal structure, and respect for the neighboring structures. By their clinical-ultrasonographic characteristics, one was considered an adenoma of the pigmented ciliary-body epithelium (browner and hyperechogenic) and two were classified as adenomas of the non-pigmented ciliary epithelium (whitish appearance and medium-echogenicity). CONCLUSION: Ultrasound biomicroscopy allows a reasonable clinicalsonographic suspicion of ACE. An initial conservative management is proposed as a safer option for stable, mildly symptomatic patients, avoiding aggressive sight threatening treatments.

OCULAR ADVERSE EVENTS ASSOCIATED WITH MEK INHIBITORS.

PURPOSE: Mitogen-activates protein kinase (MAPK) inhibitors, particularly MEK inhibitors, have shifted the treatment paradigm for metastatic BRAF-mutant cutaneous melanoma; however, oncologists, ophthalmologists, and patients have noticed different toxicities of variable importance. This review aims to provide an update of the ocular adverse events (OAEs), especially retinal toxicity, associated with the use of MEK inhibitors. METHODS: We conducted a scientific literature search using the PubMed database up to July 2018 with the terms "MEK inhibitors" with a "review" filter and "MEK inhibitors" with a "clinical trials" filter. Phase I-III experimental studies and reviews were selected. Current principles and techniques for diagnosing and managing MEK inhibitor retinopathy and other OAEs are discussed. RESULTS: In patients treated with MEK inhibitors, including asymptomatic patients, OAEs occur with an incidence of up to 90%. Mild to severe ophthalmic toxicities are described, including visual disturbances, a 2-line decrease in Snellen visual acuity, dry eye symptoms, ocular adnexal abnormalities, visual field defects, panuveitis, and retinal toxicities, such as different degrees of MEK-associated retinopathy, vascular injury, and retinal vein occlusion. CONCLUSION: MEK inhibitors can lead to different degrees of retinal, uveal, and adnexal OAE, causing visual disturbances or discomfort. One of the most relevant OAE of MEK therapy is MEK inhibitor-associated retinopathy (MEKAR), which is usually mild, self-limited, and may subside after continuous use of the drug for weeks or months, or discontinuation, thereby restoring the normal visual function of the retina, with some exceptions. Ocular adverse events are often associated with other systemic adverse effects that can modify the dosage of treatment, so the communication with the oncologist is fundamental.

BLINDNESS RELATED TO PRESUMED RETINAL TOXICITY AFTER USING PERFLUOROCARBON LIQUID DURING VITREORETINAL SURGERY.

PURPOSE: To describe the presumed retinal toxicity after using specific batches of perfluorocarbon liquid ALA OCTA (Alamedics, Dornstadt, Germany) in pars plana vitrectomy. METHODS: This is an observational retrospective consecutive case series analyses of patients operated on pars plana vitrectomy for retinal detachment or intraocular lens subluxation, using the 150141 or 200114 batches of perfluorocarbon liquid ALA OCTA as assistance during the surgery in a single center. Patients were included in this report if they manifested retinal toxicity signs throughout the follow-up, such as retinal and retinal pigment epithelium atrophy, disk paleness, and intensive macular fibrosis. Spectral domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany) and Ultra-Wide Field 200° retinal camera (Optos P200Tx; Optos, Scotland, United Kingdom) images, electrophysiological tests, and visual fields were performed to analyze the retinal structure and functionality. RESULTS: Seven of 80 patients showed all the described signs of toxicity, after a mean follow-up of 34.29 days (range: 10-87) since surgery. Four patients needed a second pars plana vitrectomy because of tractional retinal detachment and proliferative vitreoretinopathy, and two of them underwent a third surgery because of redetachment. All patients experienced amaurosis or central scotoma, with a final best-corrected visual acuity ranging from 20/200 to light perception. CONCLUSION: Presumed toxic batches of perfluorocarbon liquid may cause massive retinal toxicity. A rapid suspicion, a correct traceability of surgical products, and informing health authorities are fundamental to prevent further cases of toxicity.

Promoción de la salud sexual ante el riesgo del virus del papiloma humano en adolescentes / Promoção da saúde sexual para o risco de papilomavírus humano na adolescência / Promotion of sexual health at the risk of human papilloma virus in adolescents

Objetivo: implementar un proyecto dirigido a la promoción de la salud sexual como alternativa ante el riesgo del virus del papiloma humano (VPH) en adolescentes. Materiales y métodos: se realizó un estudio de investigación acción participativa en tres fases. En la primera se delimitaron temas y estrategias para la promoción de la salud sexual y evitar el riesgo de VPH, con la participación de adolescentes en grupos de discusión. Durante la segunda fase se realizó un programa de intervención en dos etapas: la primera consistió en sesiones informativas a cargo de instituciones, organizaciones no gubernamentales y profesionales de la salud sexual; en la segunda etapa se realizaron actividades dirigidas a promocionar la salud sexual para evitar el riesgo del VPH con el apoyo de los adolescentes. Como última fase se evaluaron las limitaciones y los alcances durante el desarrollo del proyecto. Resultados: la participación de los miembros de la comunidad permitió la definición de temas prioritarios en salud sexual y posibilitó abordarlos desde una perspectiva integral y multidisciplinaria. Conclusión: es urgente la delimitación del concepto de promoción de la salud sexual para comprender claramente cuál es el papel de los adolescentes y de qué manera se puede apostar por una participación genuina.

Objective: implement a project aimed at the promotion of sexual health as an alternative to the risk of Human Papillomavirus (HPV) in adolescents. Materials and methods: A participatory action research study was carried out in three phases. In the first, topics and strategies were defined for the promotion of sexual health and the risk of HPV, with the participation of adolescents in discussion groups. During the second phase, a two-stage intervention program was conducted: the first consisted of information sessions by institutions, non-governmental organizations and sexual health professionals; in the second stage, activities aimed at promoting sexual health were carried out to avoid the risk of HPV with the support of adolescents. The last phase evaluated the limitations and the scope during the development of the project. Results:the participation of the members of the community allowed the definition of priority topics in sexual health and made it possible to approach them from a comprehensive and multidisciplinary perspective. Conclusion: There is an urgent need to define the concept of sexual health promotion in order to clearly understand the role of adolescents and how genuine participation can be positioned.

Objetivo: implementar um projecto que visa a promoção da saúde sexual como uma alternativa para o risco de papilomavírus humano (HPV) na adolescência. Materiais e métodos: Um estudo de pesquisa-ação participativa realizada em três fases. As primeiras questões prioritárias e estratégias de promoção da saúde sexual e HPV de risco, com a participação de adolescentes em grupos de discussão foram levantadas. Durante a segunda fase de um programa de intervenção foi realizada em duas etapas: a primeira consistiu de sessões de informação por parte das instituições, associações civis e profissionais de saúde sexual; no segundo estágio, foram feitas atividades para promover sexual HPV risco para a saúde, com o apoio de adolescentes , como as restrições de fase final e escopo para o projeto foram avaliados. Resultados: A participação de membros da comunidade permitiu a definição das questões prioritárias na área da saúde sexual e permitiu resolvê-los de uma perspectiva holística e multidisciplinar. Conclusão: Há uma delimitação urgente do conceito de promoção da saúde sexual para entender claramente o que é o papel dos adolescentes e como você pode apostar em uma participação genuína.

Dominios culturales de Salud Sexual y Virus del Papiloma Humano en adolescentes mexicanos / Cultural Domains of Sexual Health and Human Papillomavirus in Mexican Adolescents

Resumen El objetivo del presente artículo es explorar la percepción de la salud sexual y del Virus del Papiloma Humano (VPH) en adolescentes del municipio de Santa María del Río, en San Luis Potosí, México. Se aplicaron las técnicas de listados libres y sorteo por montones. Las palabras higieney protección reportaron mayor frecuencia en el concepto de salud sexual, mientras que enfermedad y mortal en el concepto de VPH. La higiene como elemento dentro de los dominios de salud sexual y VPH muestra la visión acerca de quienes gozan de una buena salud sexual y de quienes padecen de una mala salud sexual. Se recomienda generar intervenciones basadas en una visión promocional de la salud sexual para el riesgo del VPH en los adolescentes.

Abstract This study was conducted to explore the perception of adolescents about sexual health and HPV in the municipality of Santa Maria del Rio, San Luis Potosi, Mexico. Two phases were undertaken using free lists and pile sorts. The words hygiene and protection were more frequently associated to the concept of sexual health, while deadly and diseases were more frequently associated to the concept of HPV. Hygiene as an element in sexual health conception and HPV shows the vision of those who enjoy a good sexual health and of those who present poor sexual health. It is important to develop interventions based on a promotional perspective of health to prevent HPV in adolescents.

Mycosis fungoides-like lesions in a patient with diffuse cutaneous sporotrichosis.

BACKGROUND: Sporotrichosis is a subacute or chronic mycosis acquired by traumatic inoculation or inhalation of fungal conidia. It is caused by the dimorphic fungus Sporothrix, which causes different clinical presentations, being the cutaneous and lymphocutaneous variants being the most frequent. The disseminated cutaneous form is a rare presentation occurring in a minority of cases in Mexico. CASE REPORT: We report an atypical case of disseminated sporotrichosis in an alcoholic and iatrogenically immunosuppressed patient, whose clinical lesions resembled tumoral-stage mycosis fungoides. Histological examination and culture revealed the presence of Sporothrix schenckii. CONCLUSIONS: The patient was treated with itraconazole 200mg per day for 4 months with clinical resolution. To the best of our knowledge, this is the first report of this type of clinical manifestation.