VITRECTOMY FOR ENDOPHTHALMITIS IN EYES WITH OSTEOKERATOPROSTHESIS.

PURPOSE: To analyze functional and anatomical results of pars plana vitrectomy (PPV) to treat endophthalmitis in eyes with osteokeratoprosthesis. METHODS: An observational, retrospective study of five eyes suffering from endophthalmitis, after an osteokeratoprosthesis implantation, which underwent PPV associated with intravitreal antibiotics. The minimum follow-up after PPV was 6 months. A descriptive study and a Kaplan-Meier survival analysis for anatomical (attached retina during the follow-up) and functional success (visual acuity ≥20/400) were performed. RESULTS: Best-corrected visual acuity during the final follow-up was 20/100 in 1 case (20%), hand movement in another case (20%), and no light perception in 3 cases (60%). The anatomical survival rates were recorded at 80%, 60%, and 40% at 1, 6, and 8 months respectively, and this last value was maintained at 12 months after PPV. The functional survival rates were recorded at 40% and 20% at 1 month and 8 months, respectively, and this last value was maintained at 12 months after PPV. CONCLUSION: Endophthalmitis in eyes with previous osteokeratoprosthesis is a very severe complication with a reserved prognosis. Pars plana vitrectomy associated with intravitreal antibiotics leads to maintaining or increasing visual acuity in a small proportion of patients who otherwise would end up blind.

Detection of graft failure in post-keratoplasty patients by automated deep learning.

PURPOSE: Detection of graft failure of post-penetrating keratoplasty (PKP) patients from the proprietary dataset using algorithms trained in Automated Deep Learning (AutoML). METHODS: This was an observational cross-sectional study, for which AutoML algorithms were trained following the success/failure labeling strategy based on clinical notes, on a cohort corresponding to 220 images of post-keratoplasty anterior pole eyes. Once the image quality criteria were analyzed and the dataset was pseudo-anonymized, it was transferred to the Google Cloud Platform, where using the Vertex AI-AutoML API, cloud- and edge-based algorithms were trained, following expert recommendations on dataset splitting (80% training, 10% test, and 10% validation). RESULTS: The metrics obtained in the cloud-based and edge-based models have been similar, but we chose to analyze the edge model as it is an exportable model, lighter and cheaper to train. The initial results of the model presented an accuracy of 95.83%, with a specificity of 91.67% and a sensitivity of 100%, obtaining an F1SCORE of 95.996% and a precision of 92.30%. Other metrics, such as the area under the curve, confusion matrix, and activation map development, were contemplated. CONCLUSION: Initial results indicate the possibility of training algorithms in an automated fashion for the detection of graft failure in patients who underwent PKP. These algorithms are very lightweight tools easily integrated into mobile or desktop applications, potentially allowing every corneal transplant patient to have access to the best knowledge to enable the correct and timely diagnosis and treatment of graft failure. Although the results were good, because of the relatively small dataset, it is possible the data have some tendency to overfitting. AutoML opens the possibility of working in the field of artificial intelligence by computer vision to professionals with little experience and knowledge of programming.

Surgical mobilization of an arterial embolus in cilioretinal artery occlusion.

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23-G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best-corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23-G soft-tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.