Ocular Syphilis with Retinal and Disc Neovascularization Treated with Bevacizumab: A Case Report.

We report the findings observed in a young woman with ocular syphilis complicated with retinal and disc neovascularization successfully treated with intravitreal bevacizumab. Fluorescein angiography revealed in both eyes intense hyperfluorescence at the level of the disc, multifocal venous wall staining, multifocal paravenous leakage, multiple peripheral saccular venular dilations, diffuse retinal and macular edema, and retinal and disc neovascularization. There was no evidence of retinal ischemia in both eyes. After antibiotic and corticosteroid treatment, the neovascularization persisted in both eyes. Three consecutive doses of intravitreal bevacizumab were administered, with total regression of the retinal and disc neovascularization. Disc and retinal neovascularization along with nonocclusive retinal vasculitis may be a form of presentation of ocular syphilis. Combination of specific treatment, oral corticosteroids, and intravitreal bevacizumab may be useful for treating this clinical manifestation.

The Role of Atropine Eye Drops in Myopia Control.

High myopia is a major cause of uncorrectable visual impairment. It imposes major challenges and costs for refractive correction, and for the treatment of associated pathological complications. In the last 60 years, there has been a marked increase in the prevalence of high myopia in younger generations in developed countries in East and Southeast Asia, and there are signs of similar, but less pronounced increases in North America and Europe. In some parts of the world, 70-90% of children completing high schools are now myopic, and as many as 20% may be highly myopic. It is now clear that myopia results from excessive axial elongation of the eye, and this greater rate of axial elongation appears to be environmentally driven. Experimental studies have examined the biochemical mechanisms involved in regulation of axial elongation; and, from these studies, some options have emerged for preventing the development of myopia or slowing myopia progression. Atropine eye drops have been quite extensively used in clinical practice in Asian countries. This long-lasting treatment could be beneficial, but has clear limitations and complications. Recent reports suggest that a low concentration of atropine, which has less severe side-effects, is also effective. But, a decision to use an invasive treatment such as atropine drops, even at low doses, requires careful consideration of the risk of myopia progression. A decision to use atropine in pre-myopic patients would require even more careful consideration of the risks. Here, we review the current literature relevant to the prevention of myopia progression with atropine drops.

Prevalence of myopic shifts among patients seeking cataract surgery.

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.

Prevalence of myopic shifts among patients seeking cataract surgery / Prevalencia de cambios miópicos en pacientes con catarata

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.(AU)

La cirugía moderna de facoemulsificación del cristalino tiene una recuperación muy rápida. La elección correcta del lente intraocular que se coloca en la cirugía permite, muchas veces, anticipar si el paciente va a precisar anteojos luego de la cirugía. Este estudio analiza una muestra de pacientes con catarata, mostrando la frecuencia relativa de cambios miópicos que permiten a los pacientes ver de cerca sin lentes antes de la cirugía. Se estudiaron retrospectivamente una serie de pacientes consecutivos que realizaron cirugía electiva de catarata. El cambio refractivo miópico fue documentado comparando las prescripciones antiguas con la medición subjetiva al momento del estudio. Los sujetos fueron agrupados de acuerdo a la presencia o ausencia de cambios miópicos, y se estudiaron las proporciones con respecto a su grado de opacidad nuclear. La edad promedio de los 229 sujetos estudiados fue de 71.5 ± 10.4 años, 109 (47.6%) varones. Se halló un cambio miópico, definido como un cambio mayor de - 0.5 dioptrías, en 85 (37.1%, IC95%: 30.8-43.4%). El porcentaje de sujetos con cambio miópico fue significativamente mayor en aquellos que tenían mayor opacidad nuclear al tiempo del examen. En este estudio de pacientes no seleccionados que buscaban realizar cirugía de catarata, más de un tercio tuvo cambios miópicos en la refracción. Si el paciente lograba ver bien de cerca antes de la cirugía, esto debería ser tenido en cuenta a la hora de elegir un correcto lente intraocular para que el sujeto no pierda este beneficio de la catarata.(AU)

Prevalence of myopic shifts among patients seeking cataract surgery. / Prevalence of myopic shifts among patients seeking cataract surgery.

Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6

, males). A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1

of subjects (95

CI: 30.8

-43.4

). The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

Patología orbitocraneana de presentación oftalmológica / Orbitocranial pathology with ophthalmologic symptoms

Objetivos. Comunicar la correlación clínico-etiológica de diferentes entidades orbitocraneanas que se presentaron inicialmente con síntomas oftalmológicos y establecer su aporte para la elección del estudio ideal de cada caso particular.Materiales y Métodos. Se analizaron retrospectivamente 36 pacientes con patología orbitaria y/o intracraneal. Las consultas fueron realizadas entre julio de 2007 y enero de 2011, y todos los casos fueron evaluados con examen oftalmológico, Campimetría Visual Computarizada, Tomografía Computada Multislice (TCMS), Resonancia Magnética (RM) y, en algunos casos, con un estudio histopatológico. Resultados. El síntoma inicial más frecuente fue la disminución o alteración de la agudeza visual, presente en 22 pacientes (61%). Otros síntomas fueron: diplopía en 9 pacientes (25%), exoftalmos en 2 (5,5%), hematoma orbitario en 2 (5,5%) y leucocoria en 1 (3%). En el grupo de pacientes que consultó por alteración visual, los diagnósticos etiológicos fueron variados e incluyeron:meningiomas esfenoidales (n=4), enfermedad de Devic (n=2), glioma mesencefálico (n=1), gliomas ópticos en NF-1 (n=2), metástasis de carcinoma de mama (n=4), linfoma cerebral (n=2), ACV (n=4), hipofisitis linfocitaria (n=1) y pseudotumor cerebri (n=2).Entre los que originalmente manifestaron diplopía, se destacaron: un tumor de lámina cuadrigémina, un quiste pineal con hidrocefalia aguda, dos aneurismas de arteria comunicante posterior, dos aneurismas de arteria carótida interna intracavernosa (uno de ellos gigante y disecante), un aneurisma ventral de la arteria carótida interna supraclinoidea y dos mucoceles fronto-etmoidales. Llama la atención que dos meningiomas el nervio óptico se presentaran inicialmente con exoftalmos y disminución de la agudeza visual en forma secundaria y que la manifestación inicial en un paciente con síndrome de West fuera leucocoria. Conclusión. El abordaje interdisciplinario y la adecuada recomendación de estudios por imágenes en...

Patología orbitocraneana de presentación oftalmológica / Orbitocranial pathology with ophthalmologic symptoms

Objetivos. Comunicar la correlación clínico-etiológica de diferentes entidades orbitocraneanas que se presentaron inicialmente con síntomas oftalmológicos y establecer su aporte para la elección del estudio ideal de cada caso particular. Materiales y Métodos. Se analizaron retrospectivamente 36 pacientes con patología orbitaria y/o intracraneal. Las consultas fueron realizadas entre julio de 2007 y enero de 2011, y todos los casos fueron evaluados con examen oftalmológico, Campimetría Visual Computarizada, Tomografía Computada Multislice (TCMS), Resonancia Magnética (RM) y, en algunos casos, con un estudio histopatológico. Resultados. El síntoma inicial más frecuente fue la disminución o alteración de la agudeza visual, presente en 22 pacientes (61%). Otros síntomas fueron: diplopía en 9 pacientes (25%), exoftalmos en 2 (5,5%), hematoma orbitario en 2 (5,5%) y leucocoria en 1 (3%). En el grupo de pacientes que consultó por alteración visual, los diagnósticos etiológicos fueron variados e incluyeron: meningiomas esfenoidales (n=4), enfermedad de Devic (n=2), glioma mesencefálico (n=1), gliomas ópticos en NF-1 (n=2), metástasis de carcinoma de mama (n=4), linfoma cerebral (n=2), ACV (n=4), hipofisitis linfocitaria (n=1) y pseudotumor cerebri (n=2). Entre los que originalmente manifestaron diplopía, se destacaron: un tumor de lámina cuadrigémina, un quiste pineal con hidrocefalia aguda, dos aneurismas de arteria comunicante posterior, dos aneurismas de arteria carótida interna intracavernosa (uno de ellos gigante y disecante), un aneurisma ventral de la arteria carótida interna supraclinoidea y dos mucoceles fronto-etmoidales. Llama la atención que dos meningiomas del nervio óptico se presentaran inicialmente con exoftalmos y disminución de la agudeza visual en forma secundaria y que la manifestación inicial en un paciente con síndrome de West fuera leucocoria. Conclusión. El abordaje interdisciplinario y la adecuada recomendación de estudios por imágenes en la evaluación de las principales entidades neuro-oftalmológicas que se presentan con signos y síntomas oculares nos permiten arribar a un diagnóstico temprano y, como consecuencia, a la implementación del tratamiento indicado.(AU)

Objectives. To report the clinical and etiological correlation of different orbitocranial lesions in patients initially presenting with ophthalmologic symptoms and to determine its contribution to the selection of the diagnostic test of choice for each individual case. Materials and Methods. We have evaluated retrospectively 36 patients with orbital and/or intracranial conditions, who presented at the ophthalmology department of our institution between july 2007 and january 2011. All patients underwent an ophthalmologic examination, computerassisted campimetry, multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and some had a histopathological test performed. Results. The most common initial symptom was decreased or impaired visual acuity, present in 22 patients (61%). Others symptoms were diplopia in 9 patients (25%), exophthalmos in 2 (5.5%), orbital hematoma in 2 (5.5%) and leukocoria in 1 (3%). In the group of patients with visual impairments, the etiological diagnoses were diverse and included: sphenoid meningioma (n=4), Devics disease (n=2), brainstem glioma (n=1), optic glioma in the context of type 1 neurofibromatosis (n=1), metastasis of breast carcinoma (n= 4), brain lymphoma (n=2), stroke (n=4), lymphocytic hypophysitis (n=1) and pseudotumor cerebri (n=2). In patients with diplopia diagnosis included: a quadrigeminal plate tumor, one pineal cyst with acute hydrocephalus, two posterior communicating artery aneurysms, two intracavernous internal carotid artery aneurysms (one of them giant and dissecting), one ventral supraclinoid internal carotid artery aneurysm and two fronto-ethmoidal mucoceles. We highlight the presence of two optic nerve meningiomas initially presented with exophthalmos and decreased visual acuity, and leukocoria as initial symptom in a West syndrome. Conclusion. The interdisciplinary approach and the proper recommendation of imaging in the evaluation of the major neuro-ophthalmologic entities that present with ophthalmologic symptoms allows us to arrive at an early diagnosis, and hence, to the institution of the appropriate therapy.(AU)

Age of lens use onset in a myopic sample of office-workers.

PURPOSE: The present study was developed to assess prevalence of myopic refractive error and the relative percentages of youth- and adult- onset myopia in a Caucasian adult population. METHODS: Subjects were office-workers sent consecutively from their workplace for a general health check-up, without refractive selection. Each subject received a questionnaire about academic achievement and family history of myopia. Subsequently, an ophthalmologist performed the vision examination. Although age of initial lens use is not necessarily the same as age of onset of myopia, it was considered to be so for this paper. A subject was considered an adult-onset myope if lens use began at age 18 or later. RESULTS: Subjects (n=349) had a mean age of 37.6 +/- 9.3 years. One hundred seventeen subjects (33.5% prevalence) had myopic spherical equivalent refraction. Further analysis comprises only subjects with simple myopia (astigmatism <1 diopter, n=95). Nearly half of the simple myopic subjects were of adult-onset (47.8%). There was no difference in family history of myopia between youth- and adult-onset myopes (at least one myopic parent in 53.1% and 47.8% respectively, p=0.53), and no clear cut-off point separated the two myopic subgroups with respect to the age of lens use onset. However, adult-onset myopes had myopia of lower diopter amount than youth-onset myopes. CONCLUSIONS: Adult-onset myopes comprised nearly half of the simple myopic subjects, and their family history of myopia was similar to that of youth-onset myopes. There is no clear cut-off point between both myopic subgroups when age of onset is the variable considered.

[Visual function study in work with computer]. / Estudio de la función visual en el trabajo con computadoras.

This investigation searched for the relationship between amount of nearwork, asthenopic symptoms and visual function, in a group of office workers engaged in telemarketing. Phoria, monocular accommodative facility with +/- 2 lens flippers and near point of convergence were measured in 100 office workers (mean age 21 +/- 2.6 years) whose uncorrected visual acuity was 20/30 or better. Daily hours of reading hard-copy and of computer use, and the level of asthenopic symptoms, were measured using a questionnaire. In this sample, telemarketers were involved 5.84 +/- 2.02 daily hours in computer use, and 2.87 +/- 2.13 daily hours in reading. The following asthenopic symptoms were present twice or more times in a week: headaches 16%, pain in the eyes 17%, red eyes 18%, blurred vision 10%, double vision 3%, burning eyes 19% and watery eyes 19%. An association was found between the amount of hours using computers and red eyes (chi 2 = 4.4, p = 0.0359) or blurred vision (chi 2 = 8.35, p = 0.0038). And also between deficit of convergence and headaches (chi 2 = 4.3313, p = 0.0374) or red eyes (chi 2 = 3.6416, p = 0.0564). No other associations could be found between the accommodative facility test results, the near point phoria, and the amount of nearwork or the asthenopic symptoms. In conclusion, computer use in telemarketing is associated with few asthenopic symptoms. Near point of convergence should be routinely measured, as it is associated with some asthenopic symptoms.

Family history and reading habits in adult-onset myopia.

PURPOSE: A retrospective study was developed to evaluate risk factors in adult-onset myopia. METHODS: Subjects included were 25 to 35 years old. There were 116 non-myopic subjects in the control group and 66 myopic subjects with first lens prescription at age 17 or later. Subjects received a questionnaire about academic achievement, daily hours of reading during years of study, and family history of myopia. RESULTS: The level of academic achievement was similar for myopic and non-myopic groups in this sample. Myopia was associated with family history (chi(2) = 6.131, p

Estudio de la función visual en el trabajo con computadoras / [Visual function study in work with computer]

This investigation searched for the relationship between amount of nearwork, asthenopic symptoms and visual function, in a group of office workers engaged in telemarketing. Phoria, monocular accommodative facility with +/- 2 lens flippers and near point of convergence were measured in 100 office workers (mean age 21 +/- 2.6 years) whose uncorrected visual acuity was 20/30 or better. Daily hours of reading hard-copy and of computer use, and the level of asthenopic symptoms, were measured using a questionnaire. In this sample, telemarketers were involved 5.84 +/- 2.02 daily hours in computer use, and 2.87 +/- 2.13 daily hours in reading. The following asthenopic symptoms were present twice or more times in a week: headaches 16

, pain in the eyes 17

. An association was found between the amount of hours using computers and red eyes (chi 2 = 4.4, p = 0.0359) or blurred vision (chi 2 = 8.35, p = 0.0038). And also between deficit of convergence and headaches (chi 2 = 4.3313, p = 0.0374) or red eyes (chi 2 = 3.6416, p = 0.0564). No other associations could be found between the accommodative facility test results, the near point phoria, and the amount of nearwork or the asthenopic symptoms. In conclusion, computer use in telemarketing is associated with few asthenopic symptoms. Near point of convergence should be routinely measured, as it is associated with some asthenopic symptoms.

Estudio de la función visual en el trabajo con computadoras. / [Visual function study in work with computer]

This investigation searched for the relationship between amount of nearwork, asthenopic symptoms and visual function, in a group of office workers engaged in telemarketing. Phoria, monocular accommodative facility with +/- 2 lens flippers and near point of convergence were measured in 100 office workers (mean age 21 +/- 2.6 years) whose uncorrected visual acuity was 20/30 or better. Daily hours of reading hard-copy and of computer use, and the level of asthenopic symptoms, were measured using a questionnaire. In this sample, telemarketers were involved 5.84 +/- 2.02 daily hours in computer use, and 2.87 +/- 2.13 daily hours in reading. The following asthenopic symptoms were present twice or more times in a week: headaches 16

, pain in the eyes 17

, red eyes 18

, blurred vision 10

, double vision 3

, burning eyes 19

and watery eyes 19

. An association was found between the amount of hours using computers and red eyes (chi 2 = 4.4, p = 0.0359) or blurred vision (chi 2 = 8.35, p = 0.0038). And also between deficit of convergence and headaches (chi 2 = 4.3313, p = 0.0374) or red eyes (chi 2 = 3.6416, p = 0.0564). No other associations could be found between the accommodative facility test results, the near point phoria, and the amount of nearwork or the asthenopic symptoms. In conclusion, computer use in telemarketing is associated with few asthenopic symptoms. Near point of convergence should be routinely measured, as it is associated with some asthenopic symptoms.