The spectrum of COVID-19-associated chorioretinal vasculopathy.

Purpose: Although conjunctivitis represents the most common ocular manifestation of COVID-19 infection, sight-threatening retinal involvement has been reported. Herein, we report and characterize with multimodal retinal imaging 5 cases of acute vision loss secondary to presumed chorioretinal vasculopathy temporally associated with COVID-19 infection with varying severity, visual morbidity, and treatment response, and review the available literature on the association between COVID-19 infection and retinal microvascular changes. Design: Observational case series and literature review. Methods: Multicenter case series of 5 patients who presented to academic centers and private offices with acute vision loss temporally associated with COVID-19 infection. A review of the literature was conducted using online databases. Results: 10 eyes of 5 patients, 3 men and 2 women, with a mean age of 30.8 years (median 33, range 16-44) were described. All patients had a recently preceding episode of COVID-19, with symptomatology ranging from mild infection to life-threatening encephalopathy. Treatment for their retinal disease included topical, oral, intravitreal, and intravenous steroids, steroid-sparing immunosuppression, retinal photocoagulation, antivirals, and antiplatelet and anticoagulant agents. Treatment response and visual recovery ranged from complete recovery of baseline acuity to permanent vision loss and need for chronic immunosuppression. Conclusions and Importance: Clinicians should be mindful of the potential for vision-threatening retinal involvement after COVID-19 infection. If found, treatment with both anti-inflammatory therapy and anticoagulation should be considered, in addition to close monitoring, as some patients with this spectrum of disease may require chronic immune suppression and/or anti-VEGF therapy.

Photoreceptor layer features in eyes with closed macular holes: optical coherence tomography findings and correlation with visual outcomes.

PURPOSE: Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS). DESIGN: Retrospective cross-sectional study. METHODS: Postoperative OCT scans were analyzed in 34 eyes of 30 patients. Raw files of horizontal and vertical OCT scans were exported to Adobe Photoshop 7.0. Measured parameters included central foveal thickness, photoreceptor thickness, photoreceptor reflectivity, and relative reflectivity of photoreceptor to retinal pigment epithelium in the foveal area. Foveal configuration was subjectively graded. RESULTS: OCT scans were obtained at a median of 2 years (1 month to 10 years) postoperatively. The median visual acuity was 20/80 (20/50 to 8/200) preoperatively and 20/50 (20/20 to 5/200) postoperatively. The median foveal thickness was 198.5 micro (148 to 283). The mean (SD) photoreceptor layer thickness was 16.5 (8) micro in the 500 micro area and 17.5 (8) micro in the 1000 micro area. Mean (SD) of relative reflectivity of the photoreceptor layer was 0.60 (0.10) in both 500 micro and 1000 micro area. Postoperative VA did not correlate with foveal thickness or foveal configuration. Central (500 micro and 1000 micro) photoreceptor thickness was significantly correlated with final VA (r = .38, P = .026, each). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 500 micro area was correlated with postoperative VA at a borderline significance (r = .32, P = .07). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 1000 micro area was not significantly correlated with postoperative VA (r = .27, P = .12). CONCLUSION: Specific retinal features can be assessed from OCT images. Morphology and thickness of the foveal photoreceptor layer correlate well with macular function after successful MHS. Outer retinal features appear to be more important to determine postoperative visual function. Inner retinal features may be more relevant for the ophthalmoscopic appearance of anatomic closure.

Corneal melt after amniotic membrane transplant.

PURPOSE: To report an eye-threatening complication associated with amniotic membrane grafting. DESIGN: Interventional case report. METHODS: Retrospective review of the clinical and surgical records of a 43-year-old man who developed melting of his corneal graft after amniotic membrane transplantation. RESULTS: Melting of a corneal graft after amniotic membrane transplantation was arrested by utilizing a tectonic, full-thickness corneal button denuded of endothelium in conjunction with a temporary tarsorraphy and systemic steroids. CONCLUSIONS: To the best of our knowledge, this is the first report of an eye-threatening complication associated with amniotic membrane grafting. Caution should be exercised in utilizing amniotic membrane in patients who have undergone multiple ophthalmologic surgical procedures, which may sensitize the ocular immune system or lead to localized ischemia.

Optical coherence tomographic findings in acute exudative polymorphous vitelliform maculopathy.

PURPOSE: To report two cases of acute exudative polymorphous vitelliform maculopathy. DESIGN: Observational case reports. METHODS: Fluorescein angiography, optical coherence tomography, and electrophysiology were performed. RESULTS: Both patients presented with sudden onset of blurred vision and bilaterally symmetric, central, and perimacular vitelliform lesions. Perimacular lesions were faintly hyperfluorescent early in the disease, but there was no abnormal fluorescence in the macular centers. Optical coherence tomography revealed anterior displacement of the photoreceptor layer by a hypereflective subretinal layer overlying a hyporeflective space above the retinal pigment epithelium-choriocapillaris complex under all lesions and no subretinal fluid. The electrooculogram was abnormal. Near complete resolution occurred over 4 to 8 months, with no improvement in the electrooculogram. CONCLUSIONS: Transient multifocal vitelliform lesions suggest a diagnosis of acute exudative polymorphous vitelliform maculopathy. Optical coherence tomography reveals characteristic anterior displacement of the photoreceptor layer by a subretinal hypereflective deposit similar to that seen in adult-onset foveomacular vitelliform dystrophy.

Etiología de la ceguera y visión subnormal en Colombia: frecuencia de enfermedad genética / Ethiology of blindness and subnormal vision in Colombia: incidence of genetic disease

La Unidad de Genética clínica del Instituto de Genética Humana de la universidad Javeriana y la Fundación oftalmológica Nacional, realizaron un estudio piloto, para determinar las diferentes causas de la ceguera y visión subnormal en población institucionalizada en Colombia. Se evaluaron 1295 personas ciegas o con visión subnormal, adscritos a 23 institutos de 17 ciudades del país. Se realizó una completa evaluación médica general y genética, personal y familiar. Se determinaron las diferentes etiologías de la limitación visual en esta población, clasificándolas en tres grandes grupos : causa genética, causa no genética y causa indeterminada. El 31.3/100 correspondió a causas adquiridas o no genéticas. El 48.5/100 a causas genéticas, mientras que en el 20.2/100 no se pudo determinar la etiología básica de la patología.