Peripapillary capillary network in dominant optic atrophy linked to OPA1 gene.

Peripapillary capillary network using optical coherence tomography angiography (OCT-A) was analysed in two siblings suffering from dominant optic atrophy linked to OPA-1 gene mutation. Peripapillary capillary network has been scarcely described in this type of optic atrophy.

Use of intravitreal rituximab and methotrexate in vitreoretinal lymphoma.

A 64-year-old Caucasian woman was referred to our hospital after referring vision loss; she had been previously diagnosed with systemic diffuse large B-cell lymphoma. Retinal and optic nerve involvement were found in her right eye, and iris and vitreous involvement were found in her left eye. Vitreoretinal lymphomas (VRL) are rare in medical literature, hence there is a lack of standardised studies regarding therapeutic options in these patients. In our patient, we decided to add intravitreal injections of rituximab and methotrexate to systemic chemotherapy, and to perform pars plana vitrectomy.

Bilateral exudative retinal detachment in undiagnosed ocular syphilis after treatment with corticosteroids.

A case of a young Caucasian male who presented bilateral papilledema is described. He was misdiagnosed with bilateral anterior optic neuritis, developing panuveitis and exudative bilateral retinal detachment after being treated with megadoses of corticosteroids. He was finally diagnosed with ocular syphilis and treated with intravenous aqueous crystalline penicillin for 14 days, with complete resolution of his symptoms.

Multimodal imaging in Susac syndrome with classic clinical triad presentation.

A 22-year-old male was referred for headaches, hearing impairment, and right eye scotoma. Branch retinal artery occlusion was revealed during the ophthalmological examination. Susac syndrome was suspected due to the symptoms described and the absence of cardiovascular risk factors. An extensive ophthalmological examination, including multimodal imaging was carried out, which is of special interest as it is considered to be a rare syndrome.

Use of plasma rich in growth factors (PRGF-Endoret®) fibrin membrane to cover corneal dellen.

Corneal dellen appeared as a complication after perilimbal conjunctival papilloma dissection in a six-year-old patient. Our purpose was to describe the use of plasma rich in growth factors (PRGF) fibrin membrane in covering the corneal defect after conventional medical treatment failure. PRGF fibrin membrane is an interesting therapeutical option to consider not only in adult patients, but also in children.

Fundus changes after cardiac surgery.

A Caucasian male with known severe aortic stenosis was referred to our Ophthalmology Department after undergoing cardiac surgery using extracorporeal circulation. Signs of retinal ischaemia were found during fundus examination and neuroimaging showed posterior cerebral artery occlusion.

Use of Vivostat PRF® in Acanthamoeba keratitis.

We present a case of a 27-year-old contact lens male user who was diagnosed with Acanthamoeba keratitis. Given the inefficiency of medical treatment and high risk of corneal perforation, we decided to use Vivostat PRF®, with satisfactory results. To our knowledge, this is the first described case in medical literature in which Vivostat PRF® is used as part of Acanthamoeba keratitis treatment.

Analysis of the influence of clinical and demographic factors on the understanding of cataract informed consent / Análisis de la influencia de factores clínicos y demográficos en la comprensión del consentimiento informado de cataratas / Análise da influência de fatores clínicos e demográficos na compreensão do consentimento informado para cirurgia de catarata

PURPOSE: To estimate the influence of clinical and demographical information in the understanding of cataract surgery informed consent, identifying less understandable areas. To assess informed consent document concept. METHODS: Multiple-choice questionnaire was designed to collect information and to evaluate the understanding of cataract surgery and informed consent. An ordinary regression model was adjusted to express the effect of clinical and demographic variables to the questionnaire score. RESULTS: The study comprised 180 patients. Sex (female, p=0.404), non-ophthalmologist source of information (p=0.397), previous surgical history (p=0.571), not having a companion (p=0.396) nor the days since the signing of informed consent form (p=0.535) had no influence in the understanding of cataract surgery informed consent. Age (r=-0.083, p<0.001) and educational level (secondary studies r=1.845, p<0.001; tertiary studies r=4.289, p<0.001) showed statistical significance with greater strength of association educational level (OR secondary studies = 6.33, OR tertiary studies = 72.86) than age had (OR = 0.92). CONCLUSION: Patient's knowledge about cataract informed consent is influenced by age and educational level. The purpose and the risks, consequences of not performing surgery and postoperative indications are the least understood topics. Informed consent is seen as a forced legal obligation.

OBJETIVOS: estimar la influencia de la información clínica y demográfica en la comprensión del consentimiento informado de la cirugía de cataratas, identificando áreas menos comprensibles. Evaluar el concepto de "documento de consentimiento informad". MÉTODOS: el cuestionario de opción múltiple se diseñó para reunir información y evaluar la comprensión de la cirugía de cataratas y el consentimiento informado. Se ajustó un modelo de regresión ordinario para expresar el efecto de las variables clínicas y demográficas en la puntuación del cuestionario. RESULTADOS: El estudio abarcó 180 pacientes. Sexo (femenino, p = 0.404); fuente de información no oftalmológica (p = 0.397); historial quirúrgico previo (p = 0.571); no tener acompañante (p = 0.396), y los días desde la firma del formulario de consentimiento informado (p = 0,535), que no tuvo influencia en la comprensión del consentimiento informado en la cirugía de cataratas. La edad (r = -0.083, p <0.001) y el nivel educativo (estudios secundarios r = 1.845, p <0.001; estudios terciarios r = 4.289, p <0.001) mostraron significación estadística con una mayor fuerza del nivel educativo de asociación (OR estudios secundarios = 6.33, OR estudios terciarios = 72.86) que la edad (OR = 0.92). CONCLUSIÓN: El conocimiento del paciente sobre el consentimiento informado en cirugía de cataratas está influenciado por la edad y el nivel educativo. Los temas menos entendidos son el propósito y los riesgos, las consecuencias de no realizar la cirugía y las indicaciones postoperatorias. El consentimiento informado se considera una obligación legal forzada.

OBJETIVO: Estimar a influência de informações clínicas e demográficas na compreensão do consentimento informado para cirurgia de catarata, identificando áreas menos compreensíveis. Avaliar o conceito do documento de consentimento informado. MÉTODOS: Um questionário de múltipla escolha foi desenvolvido para coletar informações e avaliar a compreensão sobre cirurgia de catarata e de consentimento informado. Um modelo de regressão ordinária foi ajustado para expressar o efeito das variáveis clínicas e demográficas no escore do questionário. RESULTADOS: O estudo envolveu 180 pacientes. Sexo (feminino, p=0,404), fonte de informações não oftalmológica (p=0,397), história cirúrgica prévia (p=0,571), não ter um/a companheiro/a (p=0,396) nem os dias desde a assinatura do formulário de consentimento informado (p=0,535) tiveram influência na compreensão do consentimento informado para cirurgia de catarata. Idade (r=-0,083, p<0,001) e nível educacional (estudos secundários r=1,845, p<0,001; estudos terciários r=4,289, p<0,001) mostraram significância estatística, com maior força de associação para o nível educacional (OR estudos secundários = 6,33, OR estudos terciários = 72,86) que para a idade (OR = 0,92). CONCLUSÃO: O conhecimento do paciente sobre o consentimento informado para cirurgia de catarata é influenciado pela idade e nível educacional. O objetivo e os riscos, consequências, de não fazer a cirurgia e as indicações pós-operatórias são os tópicos menos compreensíveis. O consentimento informado é visto como uma obrigação legal compulsória.

Suspected ocular toxocariasis and macular heterotopia.

We report a case of an asymptomatic Caucasian male who attended our clinic for a routine check-up and macular heterotopia associated with lesions compatible with ocular toxocariasis were found.

Retinal toxicity after facial laser epilation.

A 39-year-old man presented to the ophthalmology emergency room complaining of decreased visual acuity and metamorphopsia on his left eye after undergoing Nd:YAG facial hair epilation without wearing proper eye protection. Fluorescein angiography showed a foveal staining initially, with an increase in foveal leakage over late phases. On optical coherence tomography, a subfoveal retinal pigment epithelial detachment with associated subretinal fluid and no signs of choroidal neovascularization or cystoid macular edema was observed. Observation with monthly follow-ups was adopted. By the fourth month, the subretinal fluid had already disappeared and visual acuity had returned to 20/20. Over one-year follow-up, the retinal pigment epithelial detachment experienced a decrease in its size. Conservative management may be a valid option in assessing accidental foveal photocoagulation when choroidal neovascularization or cystoid macular edema is absent. The use of wavelength specific goggles is mandatory for the patient and the aesthetician operating the cosmetic laser, especially when operating on the face or around the eyes. Abbreviations: Nd:YAG = neodymium-doped yttrium aluminium garnet, OCT = optical coherence tomography, PED = pigment epithelial detachment, CME = cystoid macular edema.

Case Report: Evaluating Intraocular Foreign Bodies After Corneal Perforation Using Swept Source Anterior Segment Optical Coherence Tomography.

SIGNIFICANCE: Use of anterior segment optical coherence tomography (OCT) is reported, exploring its advantages over other examination techniques. PURPOSE: The purpose of this study was to report a case in which anterior segment OCT was used to evaluate the presence of intraocular bodies after corneal perforation. CASE REPORT: A 33-year-old man was referred to our ophthalmology department after traumatic ocular injury. Swept-source anterior segment was carried out showing corneal perforation and anterior lens capsule rupture. CONCLUSIONS: Evaluating the integrity of posterior capsule and iris after traumatic ocular injury with corneal perforation using anterior segment OCT is a valuable tool to rule out the presence of intraocular foreign bodies without contact and without using radiating imaging techniques.

Cyclosporine 0.1% (Ikervis®) as a corticoid-sparing agent in Lyell syndrome with KeraKlear® keratoprosthesis.

Cyclosporine 0.1% was used in a patient with Lyell syndrome, which had undergone a KeraKlear® keratoprosthesis implant due to the severe ocular involvement to avoid overuse of corticoid agents. To the best of our knowledge, this is the first reported case of cyclosporine 0.1% eye drops to use in Lyell syndrome previously treated with keratoprosthesis implant.

IgG4-related dacryocystitis and aortitis: A new association.

A 73-year-old woman with a history of muscular weakness and dyspnoea of unknown etiology was referred to our Ophthalmology Department for dacryocystitis. Lacrimal sac biopsy revealed IgG4 plasma cell infiltration and systemic diagnosis was done based on this, allowing an appropriate treatment to be established. To our knowledge, this is the first reported case of IgG4-related dacryocystitis associated to aortitis.

An unusual case of acoria in Sturge-Weber syndrome.

We present an unusual case of Sturge-Weber syndrome whose main clinical manifestations were nevus flammeus, seizures, glaucoma, and acoria. To our knowledge, the combination of Sturge-Weber syndrome and acoria has not been previously reported.

Use of Tachosil® as an adjuvant therapeutic option in neurotrophic keratopathy in order to prevent perforation.

We present two cases of women who suffered from neurotrophic keratopathy (one of them had undergone penetrating keratoplasty) which had led to corneal thinning. Tachosil® was used as an adjuvant treatment after topical medication by itself failed in both cases. To our knowledge, there are no reported cases of the use of Tachosil® in corneal grafts.

A randomized multicenter study comparing seawater washes and carmellose artificial tears eyedrops in the treatment of dry eye syndrome.

PURPOSE: To investigate the safety and efficacy of sterile isotonic seawater washes vs standard treatment with carmellose artificial tears in dry eye syndrome (DES). PATIENTS AND METHODS: This is a randomized multicenter prospective study with 12 weeks of follow-up. A group of patients with DES (N=60) were treated with seawater spray (Quinton®) five times daily, and another similar group (N=60) were treated with carmellose artificial tears eyedrops (Viscofresh® 0.5%) five times a day. The parameters studied and measured were as follows: Ocular Surface Disease Index questionnaire score, Schirmer I test (without anesthesia) score, tear osmolarity (TearLab®), tear breakup time, tear meniscus height (meniscography OCT), fluorescein corneal staining score (National Eye Institute scale), lissamine green conjunctival staining score, and levels of IL-1 beta and IL-6 in tears (Luminex® 200). RESULTS: In the group treated with seawater, symptoms decreased by 68%, and the decrease was 26% statistically superior to the group treated with carmellose artificial tears eyedrops (P<.001). Levels of IL-1 beta and IL-6 in tears significantly decreased in the seawater group compared to the carmellose artificial tears group (19%/17% vs 52%/51%) (P<0.001). There were no statistically significant differences in the other measured parameters. There were no cases of poor tolerance or side effects. CONCLUSION: Administration of seawater is more effective than treatment with carmellose artificial tears in reducing symptoms and pro-inflammatory molecules (IL-1 beta and IL-6) in tears of patients with DES.