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.

Epidemiology, clinical features, and classification of 3,404 patients with uveitis: Colombian Uveitis Multicenter Study (COL-UVEA).

PURPOSE: To describe the epidemiology, clinical features, and classification of uveitis in a large cohort of Colombian patients. METHODS: Data were collected from seven ophthalmological referral centers in the four main cities in Colombia. The study included patients with a confirmed diagnosis of uveitis from January 2010 to December 2022. Information on demographics, ophthalmic examination findings, uveitis classification, and etiology was recorded. RESULTS: The study reviewed 3,404 clinical records of patients with uveitis. The mean age at diagnosis was 41.1 (SD 19.0) years, and 54.2% of the patients were female. Overall, 1,341(39.4%) were infectious, 626 (18.4%) non-infectious, and four masquerade syndromes (0.1%). The most common types of uveitis were unilateral (66.7%), acute (48.3%), and non-granulomatous (83%). Anterior uveitis was the most common anatomical localization (49.5%), followed by posterior uveitis (22.9%), panuveitis (22.3%), and intermediate uveitis (5.2%). A diagnosis was established in 3,252 (95.5%) cases; idiopathic was the most common cause (27.7%), followed by toxoplasmosis (25.3%) and virus-associated uveitis (6.4%). The age group between 30 and 50 exhibited the highest frequency of uveitis. CONCLUSION: This multicenter study comprehensively describes uveitis characteristics in Colombian patients, providing valuable insights into its demographic and clinical features. The study findings emphasize the need to continue updating the changing patterns of uveitis to improve diagnosis and treatment strategies for diseases associated with intraocular inflammation.

Agreement between Two Swept-source Optical Coherence Tomography: Optic Nerve Head, Retinal Nerve Fiber Layer and Ganglion Cell Layers in Healthy Eyes.

Aim and background: Precision of optical coherence tomography (OCT) measurements of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular ganglion cell layer (GCL) is essential for the diagnosis and monitoring of glaucoma. The purpose of this research was to evaluate the repeatability and reproducibility of retinal and ONH parameters measured with two identical swept-source optical coherence devices. Methods: A cross-sectional study was conducted. A total of 30 eyes of 15 healthy subjects were included. Two technicians performed four OCT-wide protocol scans in the same visit using two identical Triton swept-source OCT (DRI-OCT) instruments. The interdevice and interobserver reproducibility and the repeatability of both instruments for all ONH, RNFL, and macular GCL parameters were evaluated by the intraclass correlation coefficient (ICC). Additionally, Bland-Altman test analysis was used for repeatability and reproducibility measurements. Results: Intraclass correlation coefficient (ICCs) of the ONH, RNFL, and GCL measurements were excellent for repeatability and interdevice reproducibility (>0.9). Interobserver reproducibility was good for all parameters except for RNFL clock hour 11 (ICC = 0.72). The variability of the average RNFL was from -4.103 to 4.97 µm, with a mean percentage of the difference (PD) of 0.37 ± 2.03%. Among GCL parameters, the greatest variability was found in the inferior sector (PD = -0.88 ± 5.39%, limits of agreement (LoA) = -8.345-7.078 µm). Conclusion: Using two identical swept-source OCT instruments for the evaluation of the structural parameters of the ONH, RNFL, and macular GCL showed high repeatability and reproducibility. This allows the clinician to make a therapeutic decision based on OCT findings coupled with the clinical evaluation of the patient. When evaluating RNFL clock hours measurements, interobserver reproducibility might decrease. Clinical significance: The understanding of measurement variability while using different devices and the impact of the observer capturing the images, is clinically relevant. How to cite this article: Prada AM, Tello A, Rangel CM, et al. Agreement between Two Swept-source Optical Coherence Tomography: Optic Nerve Head, Retinal Nerve Fiber Layer and Ganglion Cell Layers in Healthy Eyes. J Curr Glaucoma Pract 2023;17(2):85-90.

Clinical patterns and risk factors in scleritis: a multicentric study in Colombia.

PURPOSE: This study aims to describe the clinical characteristics of scleritis in a large cohort of Colombian patients and identify factors associated with the clinical presentation. METHODS: Retrospective case series of patients with scleritis from 2015 to 2020. Clinical records were obtained from seven uveitis referral centers in Colombia. Patients with a diagnosis of episcleritis were excluded. RESULTS: We evaluated 389 patients with scleritis (509 eyes). There was a female predominance (75.6%) with a mean age of 51 ± 15 years. Most cases were noninfectious (94.8%) and unilateral (69.2%). The most frequent type of inflammation was diffuse anterior scleritis (41.7%), followed by nodular scleritis (31.9%) and necrotizing scleritis (12.3%). Systemic autoimmune diseases were found in 41.3% of patients, the most common being rheumatoid arthritis (18.5%) and granulomatosis with polyangiitis (5.9%). Polyautoimmunity was found in 10.4% of those with a systemic autoimmune disease. The most frequent treatment was systemic steroids (50.9%), followed by systemic NSAIDs (32.4%). Steroid-sparing immunosuppression was required in 49.1% of patients. Systemic autoimmune diseases were more common in patients with necrotizing scleritis and those older than 40 years of age. Best-corrected visual acuity of 20/80 or worse at presentation was more common in necrotizing scleritis and subjects with associated uveitis, ocular hypertension, or who were over 40 years of age. CONCLUSIONS: This is the first study in Colombia and the largest in Latin America describing the clinical characteristics and presentation patterns of scleritis. The most common presentation was in females, with unilateral, anterior diffuse noninfectious scleritis. Systemic autoimmune diseases and polyautoimmunity were frequent, as was the need for steroid-sparing immunosuppression. Age over 40 and necrotizing scleritis were associated with higher odds of having a systemic autoimmune disease and worse visual acuity at presentation.

Retinocoroidopatía birdshot, reporte de un caso en Colombia / Birdshot retinochoroidopathy, case report in Colombia

Introducción: La retinocoroidopatía birdshot (RCB) es una uveítis posterior crónica, bilateral de origen autoinmune, con fuerte asociación al antígeno leucocitario humano HLA-A29. Objetivo: Describir un caso de RCB en Colombia. Material y métodos: Mujer caucásica de 57 años, con hallazgos clínicos y exámenes complementarios compatibles con RCB. Recibió terapia biológica durante 15 meses, con mejoría clínica significativa. Resultados y conclusiones: El tratamiento depende del estadio de la enfermedad y consiste en el uso solo de corticoesteroides o combinación con agentes inmunosupresores y biológicos, que han demostrado preservar la función visual y minimizar efectos adversos de los esteroides

Background: Birdshot Retinocoroidopathy (BRC) is a chronic, bilateral posterior uveitis of autoimmune origin, with a strong association with the human leukocyte antigen HLA-A29. Objective: To describe a BRC case in Colombia. Material and methods: A 57-year-old Caucasian woman with clinical findings and complementary tests compatible with BRC. She received biologic therapy for 15 months, with significant clinical improvement. Results and conclusions: Treatment depends on stage of disease and is about corticosteroid use, alone or combination with immunosuppressive and biological agents, which have been shown to preserve visual function and minimize adverse effects of steroids

Differentiation of Features of Inflammatory Neovascular Membrane Versus Active Posterior Uveitis by SS-OCTA.

BACKGROUND AND OBJECTIVE: Neovascularization is a sight-threatening, uncommon complication of posterior uveitis that often goes undetected until persistent clinical findings appear, or in light of treatment failure. This could be attributed to the relative similarity of activity signs in inflammatory neovascular membranes (NVM) and active posterior uveitis. The purpose of the present study is to recognize imaging features that distinguish uveitic neovascularization from active uveitis using swept-source optical coherence tomography angiography (SS-OCTA). PATIENTS AND METHODS: Cross-sectional study. Patients with posterior uveitis with visual acuity (VA) decrease and at least one of the following findings were assessed by SS-OCTA: retinal thickening, subretinal or intraretinal fluid, and retinal hyperreflective areas. The change of VA and imaging features after treatment with anti-vascular endothelial growth factor (VEGF) therapy were analyzed in cases with inflammatory NVM. RESULTS: Forty-five eyes of 40 patients were evaluated. Twenty-four eyes (53.3%) showed signs of activity, of which eight (33.3%) presented inflammatory NVM. Imaging features that differentiate inflammatory neovascularization from active posterior uveitis included: vitreous cellularity (P = .003), outer retinal infiltration (P = .08), choroidal thickness (P = .003), posterior shadowing (P = .013), subretinal fluid (P = .04), and neovascular network (P ≤ .001). According to NVM characteristics by OCTA, multiple anastomoses and peripheral arcades were visualized at baseline in 85.7% of cases. Mean pre-operative best-corrected VA of inflammatory NVM was 20/150 (logMAR: 0.88 ± 0.60) with significant improvement to 20/40 (logMAR: 0.32 ± 0.22) after anti-VEGF treatment (P = .027). CONCLUSIONS: SS-OCTA achieves the distinction of inflammatory NVM from active posterior uveitis through specific imaging features. Inflammatory neovascularization presents a suitable response after anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:129-137.].

Scleral fixation of a dexamethasone intravitreal implant in a case of subluxated bag-intraocular lens complex.

Macular edema is a condition of retinal tissue treated with anti-inflammatory agents including placement of an intravitreal sustained-release dexamethasone device, designed to deliver a controlled amount of the medication for a prolonged time, representing an excellent therapy. Nonetheless, the implantation cannot be carried out without an anatomical barrier, such as the presence of posterior capsular support, lens, or intraocular lens. The absence of these barriers could lead to several complications, due to migration of the device from the vitreous cavity to the anterior chamber, causing corneal endothelial damage, corneal edema, glaucoma, and uveitis, among others. In consequence, a large number of patients cannot be treated with this useful surgical tool, resulting in chronicity of macular edema and severe visual acuity impairment. Therefore, we modified the conventional technique, through scleral fixation of the device providing a continuous delivering of dexamethasone, avoiding its migration to the anterior chamber in a patient without capsular support.

An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America.

Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.

Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision.

Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma. Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere® and Contour® microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

Intravitreal bevacizumab associated with photodynamic therapy in a case of polypoidal choroidal vasculopathy associated with choroidal nevus: A case report.

RATIONALE: Report the clinical findings and management of a case of polypoidal choroidal vasculopathy associated with choroidal nevus which received combination therapy. PATIENT CONCERNS: Decreased visual acuity in a woman with polypoidal choroidal vasculopathy and choroidal nevus. DIAGNOSES: Polypoidal choroidal vasculopathy and choroidal nevus. INTERVENTIONS: The initial visual acuity was 0.5. After the first treatment with photodynamic therapy, exudation and bleeding appeared around the lesion. After this, the patient received 3 doses of intravitreal bevacizumab. OUTCOMES: After treatment with combination therapy, visual acuity, clinical and imaging findings improved, with no recurrence of exudation and bleeding. LESSONS: Intravitreal bevacizumab as an adjunctive treatment after photodynamic therapy is a good option for patients with polypoidal choroidal vasculopathy associated with choroidal nevus.

Artisan aphakic lens for cataract surgery in anterior megalophthalmos.

A 44-year-old man with anterior megalophthalmos arrived at the clinic presenting a cataract in the right eye. The corneal diameter was 13 mm. Iridodonesis and phacodonesis were evident during slit lamp examination. Anterior chamber depth was 5.89 mm, and the diameter of the capsular bag was approximately 14.45 mm. Due to the large capsular bag, a standard posterior chamber intraocular lens was considered inadequate because of potential instability. Phacoemulsification and an implantation of an iris-claw lens (Artisan for aphakia(®), Ophtec) in the posterior chamber were performed with good results. In the fourth postoperative month, uncorrected distance visual acuity was 20/30, and 20/20 was achieved with +0.75 -1.25 × 10°. We consider retropupillary aphakic iris-claw intraocular lenses to be a worthwhile option in these cases of megalophthalmos and cataract, since instability is avoided and the procedure is less challenging than suturing the lens.

Study of heavy metal concentration and partitioning in the Estrela River: implications for the pollution in Guanabara Bay ­ SE Brazil.

In this study, the geochemical analysis of ten sediment samples collected along the fluvial system of the Estrela River, which flows into the northern portion of Guanabara Bay, shows the presence of anthropogenic impacts in this area. Concentrations of Fe, Mn, Zn, Cu, Pb, Cr and Ni obtained were slightly higher, when compared with values found in natural environments. The particle size and organic matter content in most of the analyzed stations showed features not conducive to the accumulation of pollutants due to the low organic matter content and the strong presence of sand fraction. There was also the fractionation of heavy metals in sediments and it was found the prominence of residual and reducible phase, besides the significant occurrence of organic fractions in some analyzed stations. These factors, thus, highlight the potential risks of contamination, where the metals associated with the organic phase can become bioavailable in processes of dissolution, provided by physico-chemical changes that can occur in this aquatic environment.

Study of heavy metal concentration and partitioning in the Estrela River: implications for the pollution in Guanabara Bay - SE Brazil

In this study, the geochemical analysis of ten sediment samples collected along the fluvial system of the Estrela River, which flows into the northern portion of Guanabara Bay, shows the presence of anthropogenic impacts in this area. Concentrations of Fe, Mn, Zn, Cu, Pb, Cr and Ni obtained were slightly higher, when compared with values found innatural environments. The particle size and organic matter content in most of the analyzed stations showed featuresnot conducive to the accumulation of pollutants due to the low organic matter content and the strong presence ofsand fraction. There was also the fractionation of heavy metals in sediments and it was found the prominence ofresidual and reducible phase, besides the significant occurrence of organic fractions in some analyzed stations. Thesefactors, thus, highlight the potential risks of contamination, where the metals associated with the organic phase canbecome bioavailable in processes of dissolution, provided by physico-chemical changes that can occur in this aquaticenvironment.

Neste estudo, analises geoquímicas de dez amostras de sedimentos coletadas ao longo do sistema fluvial do rio Estrela, que deságua na porção norte da Baía de Guanabara, evidenciam a presença de impactos antropogênicos nesta área. As concentrações de Fe, Mn, Zn, Cu, Pb, Cr e Ni obtidas foram ligeiramente elevadas, quando comparados com valores encontrados em ambientes naturais. A granulometria e o teor de matéria orgânica na maioria dos pontos analisados mostraram características não favoráveis à acumulação destes poluentes devido à baixa concentração de matéria orgânica e à forte presença de fração areia. Realizou-se também o fracionamento dos metais pesados nos sedimentos e constatou-se a preeminência da fase residual e redutível, além da ocorrência significativa da fração orgânica em alguns pontos analisados. Estes fatores evidenciam, portanto, riscos potenciais de contaminação, onde os metais associados à fase orgânica podem se tornar biodisponíveis em processos de solubilização, proporcionados por mudanças físico-químicas que podem ocorrer neste ambiente aquático.