Vitrectomy-Assisted Excision in the Treatment of Juxtapapillary Retinal Capillary Hemangioma.

Juxtapapillary retinal capillary hemangiomas are sight-threatening hamartomas located on or adjacent to the optic nerve. Nonsurgical approaches including laser photocoagulation and cryotherapy have been shown to be effective to reduce exudation in peripheral hemangiomas. However, in juxtapapillary hemangiomas, the functional outcomes are limited due to associated potential damage of the retinal nerve fiber layer. We present an 18-year-old female patient with von Hippel-Lindau (VHL) disease who presented with a juxtapapillary retinal capillary hemangioma associated with a tractional epiretinal membrane (ERM) and secondary macular hole. After vitrectomy-assisted excision of the lesion and inner limiting membrane (ILM) peeling around the macular hole, visual acuity and macular anatomy were recovered at 10 months of follow-up. [Ophthalmic Surg Lasers Imaging Retina 2022;53:570-573.].

Iberoamerican Ophthalmologists IOL Selection for Use on Themselves: Survey Results.

PURPOSE: To determine the preferred type of intraocular lens (IOL) that ophthalmologists would choose for themselves in case of cataract surgery. DESIGN: Prospective convenience questionnaire study. MATERIALS AND METHODS: We developed an electronic survey with seven (7) questions, combining multiple and open options. The following categories were established: monofocal (MonoIOL) without monovision (MonoIOL-SM) and with monovision (MonoIOL-CM) and multifocal (MultiIOL) that could be either a bifocal (MultiIOL-B), trifocal (MultiIOL-T) or extended focus (MultiIOL-E). The link for the survey was sent to ophthalmologists from Latin America and Spain through different ways. The 1209 responses were analyzed statistically. RESULTS: We received 1209 responses from 14 countries. The average age was 47.977 years (SD 11.711 years). Gender distribution was 839 males (72.8%) and 313 females (27.2%). Overall preference was MonoIOL-SM 23.90% (289), MonoIOL-CM 12.16% (147), MultiIOL-B 4.63% (56), MultiIOL-T 34.99% (423), MultiIOL-E 15.22% (110), and unsure 9.10% (110). Ophthalmologists that implant IOLs showed a greater preference for MultiIOL (64%) than those who did not implant IOLs (32.3%). Although all ophthalmologists preferred MultiIOL, anterior segment specialists chose them more frequently (59.1%) than posterior segment specialists (41%). CONCLUSION: Ophthalmologists would prefer to receive a multifocal IOL implantation despite the lower frequency of multifocal IOL implantation observed in the general population. The frequency was greater among ophthalmologists who implant IOLs compared to those who do not implant them. It was also greater among those who identified themselves as anterior segment specialists compared to posterior segment specialists.

Hypertensive Retinopathy and All-Cause Mortality in Older Adults of Amerindian Ancestry. A Population-based Longitudinal Prospective Study.

INTRODUCTION: Hypertensive retinopathy (HTRP) predicts all-cause mortality in Asian and Caucasian populations. However, little is known about HTRP impact in other ethnic groups. AIM: We sought to estimate the mortality risk according to HTRP severity in older adults of Amerindian ancestry living in rural Ecuador. METHODS: This prospective study enrolled individuals aged ≥ 60 years with baseline blood pressure ≥ 120/≥ 80 mmHg from the ongoing Atahualpa Project cohort who received retinal photographs (for HTRP grading) and a brain MRI. We ascertained all-cause mortality after a mean of 5.2 ± 1.2 years of follow-up. Cox-proportional hazards models adjusted for demographics, cardiovascular risk factors, neuroimaging signatures of cerebral small vessel disease, blood pressure determinations during follow-up and incident strokes, were obtained to estimate mortality risk according to HTRP severity. RESULTS: Analysis included 236 participants (mean age 69.3 ± 7.3 years). HTRP Grade 2 or higher was determined in 42 (18%) individuals. Fifty participants (21%) died during the follow-up, resulting in an overall unadjusted crude mortality rate of 4.1 per 100 person-years. Mortality rate in subjects with HTRP Grade 2 or higher was 7.2 and in those with no HTRP or Grade 1 only was 3.4 per 100 person-years. An adjusted Cox-proportional hazard model showed that individuals with HTRP Grade 2 or higher maintained a greater than two-fold mortality risk (HR 2.08; 95% C.I. 1.04-4.15; p = 0.038) when compared to those with no HTRP or Grade 1 only. CONCLUSION: Study results show that HTRP severity predicts mortality in this population of older adults.

En face swept-source optical coherence tomography angiography choroidal vasculography (CVG) a tool to discriminate choroidal abnormalities in polypoidal choroidal vasculopathy.

BACKGROUND: Swept source optical coherence tomography angiography (SS-OCT-A) choroidal vasculography (CVG) is an imaging method which allows the evaluation of deep choroid details, being a promising too in choroidal pathologies as polypoidal choroidal vasculopathy (PCV). RESEARCH DESIGN AND METHODS: Cross-sectional study performed at FOSCAL International Clinic in Colombia. CVG features in patients with PCV were evaluated using SS-OCT CVG. RESULTS: Twenty-two eyes of 21 patients were included. The mean age was 72.7 ± 6.5 years old (range: 48.6-95.4 years old). Twelve (57.1%) patients were male. The mean number of polyps detected by SS-OCT-A CVG before treatment with anti-VEGF therapy was 2.04 ± 1.18, which decreased after treatment to 1.18 ± 0.71. This result was statistically significant (p < 0.05). All polypoidal lesions detected by B-scan were visualized using CVG. Polyp circularity and surrounding reflectivity indicated activity of disease. CONCLUSION: En face SS-OCT-A CVG is an alternative tool to evaluate choroidal structure at different depths without a contrast dye, providing information for the diagnosis and follow-up of patients with PCV. This imaging modality do not pretend to replace gold standard tests in PCV as ICGA, but rather provides choroidal imaging features of PCV, when ICGA is not available.

Early microvascular changes in patients with prediabetes evaluated by optical coherence tomography angiography.

BACKGROUND: Timely detection of early microvascular changes in patients with prediabetes could help reduce the likelihood of progression of diabetes-related retinal complications. AIM: To determine early microvascular changes in patients with prediabetes using optical coherence tomography angiography (OCT-A). METHODS: In this single-center retrospective case-control study, macular OCT-A images of superficial capillary plexus (SCP) and deep capillary plexus (DCP) were analyzed in non-diabetic controls, and prediabetic and diabetic subjects. A quantitative analysis was performed using ImageJ software of the foveal avascular zone (FAZ) area, acircularity index (AI), perfusion density (PD), and vascular length density (VLD). RESULTS: A total of 94 eyes of 53 patients were included in this study. The global mean age was 57.7 years, 39.6% men and 60.4% women. In SCP, the mean PD was 0.283 ± 0.15, 0.186 ± 0.720, and 0.186 ± 0.07 in non-diabetic controls, and prediabetic and diabetic groups, respectively. The mean VLD was 8.728 ± 3.425 in non-diabetic controls, 6.147 ± 1.399 in prediabetic group, and 6.292 ± 1.997 in patients with diabetes. The comparison of prediabetic patients and controls shows statistical differences between PD and VLD in both plexus SCP (p = 0.002 and p = 0.001, respectively) and DCP (p = 0.005 and p = 0.002, respectively). The mean area of FAZ in patients with diabetes and normal individuals was 0.281 and 0.196 mm2, respectively (p < 0.001). AI was higher in the control group (0.87 ± 0.14) and prediabetic group (0.80 ± 0.17) compared to diabetic patients (0.64 ± 0.19). There were no differences in FAZ area and AI between prediabetic and non-diabetic controls. CONCLUSION: PD and VLD demonstrated to be early microvascular changes in prediabetic patients evaluated by OCT-A. No alterations of FAZ were evidenced in this group.

Availability of personal protective equipment and diagnostic and treatment facilities for healthcare workers involved in COVID-19 care: A cross-sectional study in Brazil, Colombia, and Ecuador.

Many affected counties have had experienced a shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. We aimed to investigate the needs of healthcare professionals and the technical difficulties faced by them during the initial outbreak. A cross-sectional web-based survey was conducted among the healthcare workforce in the most populous cities from three Latin American countries in April 2020. In total, 1,082 participants were included. Of these, 534 (49.4%), 263 (24.3%), and 114 (10.5%) were physicians, nurses, and other professionals, respectively. At least 70% of participants reported a lack of PPE. The most common shortages were shortages in gown coverall suits (643, 59.4%), N95 masks (600, 55.5%), and face shields (569, 52.6%). Professionals who performed procedures that generated aerosols reported shortages more frequently (p<0.05). Professionals working in the emergency department and primary care units reported more shortages than those working in intensive care units and hospital-based wards (p<0.001). Up to 556 (51.4%) participants reported the lack of sufficient knowledge about using PPE. Professionals working in public institutions felt less prepared, received less training, and had no protocols compared with their peers in working private institutions (p<0.001). Although the study sample corresponded to different hospital centers in different cities from the participating countries, sampling was non-random. Healthcare professionals in Latin America may face more difficulties than those from other countries, with 7 out of 10 professionals reporting that they did not have the necessary resources to care for patients with COVID-19. Technical and logistical difficulties should be addressed in the event of a future outbreak, as they have a negative impact on healthcare workers. Clinical trial registration: NCT04486404.

Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project.

BACKGROUND: Diagnosis of cerebral small vessel disease (SVD) is a challenge in remote areas where MRI is not available. Hypertensive retinopathy (HTRP) has shown to correlate with SVD in different ethnic groups, but there is no information from indigenous Latin American people. We assessed the usefulness of retinal photographs to detect cases with SVD among Amerindians living in rural Ecuador. METHODS: Atahualpa residents aged ≥60years with arterial hypertension or prehypertension were identified during a door-to-door survey. A confocal line scanning laser ophthalmoscope was used to identify and grade HTRP (according to the Keith-Wagener-Barker classification). MRIs were read with attention to the presence of white matter hyperintensities (WMH) of presumed vascular origin and lacunar infarcts. Using logistic regression models, we evaluated whether HTRP was independently associated with neuroimaging signatures of SVD. RESULTS: Of 323 eligible candidates, 241 (75%) were enrolled. MRI readings revealed moderate-to-severe WMH in 49 (20%) cases and lacunar infarcts in 29 (12%). HTRP Grade 1 was noticed in 90 (37%) individuals and Grade 2-3 in 42 (17%). After adjusting for demographics and cardiovascular risk factors, multivariate analyses showed a significant association between Grades 2-3 HTRP and moderate-to-severe WMH (OR: 3.87, 95% C.I.: 1.64-9.13) but not with lacunar infarcts (OR: 2.22, 95% C.I.: 0.83-5.92). CONCLUSION: Amerindians with HTRP Grades 2-3 are almost four times more likely to have SVD-related subcortical damage than those with no- or only Grade 1-HTRP. Retinal photographs might allow recognition of people who need further investigation and therapy.

Infiltration of proinflammatory m1 macrophages into the outer retina precedes damage in a mouse model of age-related macular degeneration.

Age-related macular degeneration (AMD) is a major cause of blindness in the developed world. Oxidative stress and inflammation are implicated in AMD, but precise mechanisms remain poorly defined. Carboxyethylpyrrole (CEP) is an AMD-associated lipid peroxidation product. We previously demonstrated that mice immunized with CEP-modified albumin developed AMD-like degenerative changes in the outer retina. Here, we examined the kinetics of lesion development in immunized mice and the presence of macrophages within the interphotoreceptor matrix (IPM), between the retinal pigment epithelium and photoreceptor outer segments. We observed a significant and time-dependent increase in the number of macrophages in immunized mice relative to young age-matched controls prior to overt pathology. These changes were more pronounced in BALB/c mice than in C57BL/6 mice. Importantly, IPM-infiltrating macrophages were polarized toward the M1 phenotype but only in immunized mice. Moreover, when Ccr2-deficient mice were immunized, macrophages were not present in the IPM and no retinal lesions were observed, suggesting a deleterious role for these cells in our model. This work provides mechanistic evidence linking immune responses against oxidative damage with the presence of proinflammatory macrophages at sites of future AMD and experimentally demonstrates that manipulating immunity may be a target for modulating the development of AMD.

Impact of ocular surface symptoms on quality of life in a United States veterans affairs population.

PURPOSE: To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services. DESIGN: Cross-sectional survey study. METHODS: setting: Miami Veterans Affairs Medical Center (VAMC). patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire. main outcome measures: Correlation between ocular surface symptoms and functionality. RESULTS: Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit. CONCLUSION: Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.

Búsqueda de substitutos para estudios de neuroimagen con propósitos de investigación: Experiencia del Proyecto Atahualpa / The search of surrogates for neuroimaging studies for research purposes: The Atahualpa Project Experience

RESUMEN El diagnóstico de muchas de las enfermedades neurológicas no transmisibles requiere de la práctica de una resonancia magnética, la cual no se encuentra disponible en regiones rurales o remotas. Es importante realizar esfuerzos destinados a encontrar pruebas diagnósticas portátiles que sirvan como tamizaje para la identificación de personas que necesitan ser sometidas a una IRM. Como parte del Proyecto Atahualpa, hemos invitado a todos los participantes ≥60 años para la práctica de una IRM de cerebro y aproximadamente el 80% de las personas han aceptado el procedimiento. Por lo tanto, tenemos la oportunidad única de probar la validez de pruebas no-invasivas que puedan ser utilizadas como substitutos de resonancia para identificar candidatos a hacerse dicho examen. Hasta la fecha, hemos estudiado el valor del índice tobillo-brazo, la confiabilidad de la relación neutrófilos-linfocitos, la exactitud de la presencia de retinopatía hipertensiva y el valor del Doppler transcraneal para la detección de personas con enfermedad de pequeño vaso cerebral. Los individuos con índice tobillo-brazo anormal tiene 4 veces más riesgo de tener un infarto lacunar silente que aquellos con índice normal. Una relación neutrófilos-linfocitos elevada es pobremente sensitiva pero altamente específica para detectar personas con por lo menos un marcador de imagen de enfermedad de pequeño vaso. Los individuos con retinopatía hipertensiva Grados 2-3 tienen casi 4 veces más riesgo de tener hiperintensidades de sustancia blanca que aquellos con retinopatía Grado 1 o sin retinopatía. Finalmente, la correlación del índice de pulsatilidad de las arterias intracraneales para detectar marcadores de enfermedad de pequeño vaso es pobre. Seguimos en la búsqueda de una prueba económica y confiable que permita la identificación de sujetos aparentemente sanos, con riesgo de desarrollar eventos cerebrovasculares catastróficos.

ABSTRACT Diagnosis of many non-communicable neurological diseases require the use of MRI, which is not readily available in remote rural populations. Efforts should be directed to find portable screening diagnostic tools that may help identify candidates for MRI screening. In the Atahualpa Project, all participants aged ≥60 years have been invited for the practice of MRI, and about 80% of them have underwent the procedure. Therefore, we have the unique opportunity to test the accuracy of non-invasive exams to be used as surrogates to MRI for identifying candidates for the practice of this exam. To date, we have assessed the value of the ankle-brachial index ABI), the reliability of the neutrophil-to-lymphocyte ratio (NLR), the accuracy of hypertensive retinopathy, and the value of transcranial Doppler (TCD) to detect individuals with cerebral small vessel disease. Individuals with an abnormal ABI have 4 times de odds of having a silent lacunar infarct than those with a normal ABI. A high NLR has a poor sensitivity but is highly specific for detecting persons with at least one imaging signature of small vessel disease. Individuals with hypertensive retinopathy Grades 2-3 are almost four times more likely to have moderate-to-severe white matter hyperintensities than those with no- or only Grade 1 retinopathy. Finally, the correlation between the pulsatility indexes of major cerebral arteries with imaging markers of small vessel disease, as assessed by TCD, was poor. We are still in the search of some non-expensive and readily available biomarker that allow the identification of apparently healthy persons at risk of suffering a catastrophic cerebrovascular event.

Queratografia com flash anular / Keratography with annular flash

La finalidad de este trabajo es describir un procedimiento práctico y sencillo destinado a obtener queratografías, utilizando básicamente un flash anular y equipo fotográfico de uso común