FLACS (Femtosecond-Laser-Assisted Cataract Surgery) combined with pupiloplasty in iris-lens coloboma.

Purpose: To describe the use of FLACS (Femtosecond-Laser-Assisted Cataract Surgery) and pupiloplasty technique employed in a cataract surgery associated with iris-lens-zonule coloboma, as well as to report the advantages that FLACS can provide in this type of complicated surgery. Observations: During FLACS (Victus® - TECHNOLAS, Bausch and Lomb Incorporated, USA), after the docking procedure, the parameters of capsulotomy, fragmentation and incisions were manually adjusted. Iris retractors were anchored to the edge of the anterior lens capsule to provide stability to the bag during phacoemulsification maneuvers, and a capsular tension ring and intraocular lens (IOL) were implanted. Iris repair was approached using a modification of the slip-knot technique. For this purpose, a 10.0 Prolene on a straight needle was used and knotted extraocularly, over the conjunctiva. Finally, an anterior vitrectomy was performed as a precaution. Conclusions and importance: In spite of the existing controversy regarding FLACS technology compared to conventional surgery, it seems to be beneficial in complicated cases such as cataracts associated with iris and lens coloboma, since it allows the modification of different parameters that facilitate and ensure surgery safety. On the other hand, the iris repair technique described facilitates manipulation of the iris sutures. In addition, complementary techniques such as the use of a capsular tension ring and pupiloplasty help to center and stabilize the IOL, and to reduce the symptoms derived from iris coloboma, obtaining a better visual quality.

Tomographic Findings in the Retina of Unvaccinated Patients with COVID Pneumonia: Prospective Longitudinal Study.

There is no definitive evidence on the extent of SARS-CoV-2's effect on the retina. This study aims to determine if the natural history of SARS-CoV-2 infection affects tomographic findings in the retina of patients with COVID-19 pneumonia. This is a prospective cohort study of patients hospitalized with COVID-19 pneumonia. The patients underwent ophthalmological explorations and optical coherence tomography during the acute phase of the infection and at a follow-up 12 weeks later. The primary outcomes were the central retinal thickness and central choroidal thickness, which were compared longitudinally and with non-COVID-19 historical controls. No statistically relevant differences were observed in the longitudinal analysis of the thickness of the central retina (p = 0.056), central choroid (p = 0.99), retinal nerve fiber layer (p = 0.21), or ganglion cell layer (p = 0.32). Patients with acute COVID-19 pneumonia showed significantly greater central retinal thickness than non-COVID controls (p = 0.006). In conclusion, tomographic measures of the retina and choroid are not influenced by the phase of COVID-19 infection and remain stable during 12 weeks. The central retinal thickness may increase in the acute phase of COVID-19 pneumonia, but more epidemiological studies using optical coherence tomography in the early stages of the disease are needed.

Presumed bilateral acute retinal necrosis 11 years apart, atypical presentation, and early vitrectomy.

PURPOSE: To report a case of presumed bilateral acute retinal necrosis with delayed onset caused by herpes simplex virus type 2, medical treatment, and surgical approach. METHODS: Retrospective, interventional case described in a 51-year-old patient who complained of unilateral blurred vision with history of nonoperated retinal detachment in his fellow eye after posterior uveitis 11 years earlier. RESULTS: Ocular examination suggested diagnosis of acute retinal necrosis involving the posterior pole and sparing periphery. The causative agent was demonstrated using polymerase chain reaction analysis of the aqueous humor. Intensive medical treatment with intravenous acyclovir, intravitreous foscarnet, and corticosteroids was administered, slowing down but not stopping progression of the disease. Due to the monocular status of the patient and high probability of secondary retinal detachment, early vitrectomy was indicated. CONCLUSIONS: Rapid and aggressive medical treatment is necessary in this condition. Bilateral involvement often occurs within weeks, but can also happen more rarely after several months or years, requiring long-term follow-up. Early surgical treatment is controversial but it is an option to be considered in certain cases.