Primary Vitrectomy versus Tap and Inject for Fungal Endophthalmitis: Meta-Analysis and Comparison with Data from a Reference Centre.

PURPOSE: We aimed to compare the visual outcomes after pars plana vitrectomy (PPV) versus tap and inject (T&I) in fungal endophthalmitis (FE) reported in the literature and to compare the findings from the literature with data from a reference centre. METHODS: We performed a systematic review and meta-analysis of studies reporting the use of PPV versus T&I in FE. We also performed a retrospective review of the clinical records of patients with endophthalmitis from a reference centre in Colombia. RESULTS: We included 13 studies with 334 eyes; 53.59% received PPV and 46.4% received T&I. The overall relative risk of improving ≥ 2 lines in PPV versus T&I was 0.98 (95% confidence interval [CI] 0.80-1.22; p = 0.88) with a mean difference of final visual acuity of 0.26 (95% CI 0.12-0.63; p = 0.18). There were no significant differences in subgroup analysis. Data from the reference centre included 32 endophthalmitis cases, 15.6% of which had a fungal aetiology (80% received PPV and 20% T&I). There were no significant differences in the subgroup analysis. CONCLUSIONS: Based on the findings from the literature and the reference centre, T&I is noninferior to PPV. This is the first meta-analysis in the literature evaluating these effects in FE. It is necessary to execute new prospective randomised controlled studies in patients with endophthalmitis.

PLASMA RICH IN GROWTH FACTORS FOR PERSISTENT MACULAR HOLE: A PILOT STUDY.

PURPOSE: Persistent macular hole (PMH) is a challenge for retina surgeons. There are limited surgical techniques described achieving PMH closure. For more than a decade, techniques with blood derivatives have been described without optimal outcomes. The aim of this article is to report the usefulness of the plasma rich in growth factors (PRGF) as a new way to improve PMH closure. METHODS: This is an observational study. Two patients with PMH were chosen at the FOSCAL Internacional, Floridablanca, Colombia. For each patient, a complete ophthalmological examination before and after treatment was performed. It included best-corrected visual acuity and fundus examination. Features of swept-source optical coherence tomographic angiography (Topcon) at baseline and after treatment were included. Preoperative evaluation included the following: previous vitreoretinal surgery for macular hole, macular hole measurement and classification, and dissociated optic nerve fiber layer in en-face map, confirming a prior internal limiting membrane peeling. Plasma rich in growth factors-Endoret technology is characterized by moderate platelet concentration and absence of leukocytes, which requires calcium chloride for platelet activation. It is obtained from each patient's blood sample, submitted to a series of processes to acquire a three-dimensional fibrin scaffold, rich in hundreds of proteins, which seems to have therapeutic potential. This PRGF membrane is placed into the macular hole with forceps through a pars plana vitrectomy after complete air-fluid exchange. Supernatant was placed on the macula and left it for 2 minutes. It is then aspirated, and gas or silicone oil was left as a tamponade. RESULTS: Follow-up period was of 12 months for each patient. Complete macular hole closure was achieved in both cases. Best-corrected visual acuity changed from 20/200 preoperatively to 20/100 postoperatively in Patient #1 and from 20/1,500 to 20/100 in Patient #2. CONCLUSION: Plasma rich in growth factors has been primarily investigated for ocular surface diseases. This is a pilot study using this technology for PMH treatment. The use of PRGF may be an effective and safe surgical technique with satisfactory anatomical and functional results for PMH. Because of its own biomaterials and proteins, PRGF not only allows anatomical closure but also seems to stimulate tissue regeneration.

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.

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.

Heads up Descemet membrane endothelial keratoplasty performed using a 3D visualization system.

A 68-year-old female underwent Descemet membrane endothelial keratoplasty (DMEK) in her right eye using a 3D visualization system with the surgeon looking directly to a digital screen instead of through the eyepieces of the surgical microscope. The procedure was uneventful. Five weeks after the surgery the DMEK graft was in good position and totally adhered, the cornea clear and uncorrected distance visual acuity 20/50. This is the first reported case of DMEK using 3D augmented reality visualization system. It seems to offer advantages for the corneal surgeon in critical steps of the endothelial grafting procedure.

Epidemiology of childhood ocular trauma in a northeastern Colombian region.

OBJECTIVE: To describe the epidemiology of ocular trauma in children 15 years and younger who underwent evaluation during a 5-year period in the emergency department of a tertiary referral center in northeastern Colombia. METHODS: We retrospectively reviewed the medical records of children 15 years and younger. Records of 393 children with 415 incidents of eye injury were included in the study, of whom 22 were initially treated for bilateral ocular trauma. RESULTS: Most patients (64.9%) were boys. The highest proportion of injuries (44.4%) occurred at home, followed by streets and roads (28.6%). Blunt (35.1%) and sharp (22.6%) objects represented the most frequent causes of trauma. Closed-globe injuries were far more frequent than open-globe injuries for boys (82.4% vs 17.6%) and girls (83.8% vs 16.2%). Of those with closed-globe injuries, 253 injuries (80.0%) registered an initial visual acuity of greater than 20/60, whereas 31 open-globe injuries (52.5%) registered an initial visual acuity of less than 20/400. Most closed-globe injuries (223 [92.1%]) did not cause any final visual impairment in the affected eye, whereas 26 open-globe injuries (55.3%) caused severe visual impairment or blindness. CONCLUSIONS: Most of the accidents reported in this study could have been avoided; the data demonstrate a clear need for primary prevention and control measures.