Use of Amniotic Membrane Transplant and Deep Anterior Keratoplasty in a Patient with Bilateral Acanthamoeba Infectious Keratitis: A Case Report.

The aim of this study was to report a case with the use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral Acanthamoeba infectious keratitis as a treatment. A 20-year-old male presented with bilateral Acanthamoeba keratitis (AK) who was initially diagnosed with herpetic keratitis receiving full antiviral and corticosteroid topical treatment without any improvement. Corneal biopsy was performed to confirm the suspected diagnosis, and Acanthamoeba stromal cysts were identified in the sample. Treatment was initiated with 0.02% chlorhexidine, 0.1% propamidine isethionate, neomycin, and tropicamide/phenylephrine. Symptoms and clinical improvement were achieved between the 8th and 10th weeks, so corticosteroids were initiated. Treatment was continued until we observed a poor response in the left eye; therefore, an epithelial scraping and amniotic membrane placement were performed. Lately, the right eye underwent a deep anterior lamellar keratoplasty. A challenging case of bilateral AK managed with topical medications, amniotic membrane, and corneal keratoplasty. The earlier the disease is diagnosed, the better the outcome. If the diagnosis is delayed, the amoebas have penetrated deep into the corneal stroma, and successful therapy becomes difficult. A surgical option can be an early solution with a good prognosis for these cases.

Ophthalmic findings in patients with autosomal recessive lamellar ichthyosis due to TGM1 mutations in an isolated population.

PURPOSE: To describe the ocular clinical characteristics of a group of Mexican patients with lamellar ichthyosis (LI) arising from TGM1 pathogenic variants. METHODS: Ophthalmological exploration, pedigree analysis and genetic screening were performed in patients with an established clinical diagnosis of lamellar ichthyosis from families located in a small community in the Southeast of Mexico. RESULTS: Nine patients with LI in five families were identified. There were six affected females. All patients (9/9) demonstrated eye lid abnormalities with eight patients showing lid margin abnormalities. Madarosis was present in only three individuals and corneal scarring was documented in two. All nine individuals carried biallelic TGM1 variants, either homozygously or as compound heterozygous. CONCLUSION: Ocular anomalies are common in individuals with TGM1-related LI. The occurrence of a variety of private or rare mutations hampers the identification of a genotype-phenotype correlation for ocular anomalies in this disorder.

Características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular que acuden a un centro de referencia en oftalmología en Paraguay

Introducción: La toxoplasmosis es una enfermedad parasitaria, en América Latina la prevalencia es relativamente alta, se sabe que la enfermedad no solo es la causa más frecuente de uveítis posterior, sino también la causa principal de la uveítis en sí misma. En Paraguay no se dispone de datos epidemiológicos publicados sobre la misma. Objetivo: Determinar las características de las lesiones retinianas en pacientes con diagnóstico de Toxoplasmosis ocular. Metodología: El presente estudio es observacional, descriptivo, de corte transversal, temporalmente retrospectivo, con muestreo no probabilístico de casos consecutivos. Se enfocó en pacientes con diagnóstico de Toxoplasmosis que acudieron al servicio de Oftalmología del Hospital de Clínicas, durante el periodo de junio de 2020 a febrero 2022. Resultados: Se observó un 54,3 % de mujeres, una media de 30,62 +/- 12,96 años y un 62,8 % de procedencia urbana. El 88,3 % de los casos fueron unilaterales, la mitad de episodios primarios, el 93,6 % casos agudos, y el 97,9 % tuvo un mecanismo de trasmisión adquirido. La mayoría se presentó como Panuveítis, las localizaciones más frecuentes de las lesiones retinocoroideas fueron el Polo posterior (extramacular) y la periferia. El principal abordaje terapéutico fue el tratamiento con Trimetoprim Sulfametoxazol y corticoides sistémicos, la duración del tratamiento fue de 6,51 +/- 1,52 semanas, y las principales complicaciones fueron la Vitritis residual y la Hipertensión ocular. Discusión: La toxoplasmosis ocular es una causa importante de morbilidad visual. Se hace fundamental la prevención de la infección por este parásito mediante medidas higiénico-sanitarias, así como el diagnóstico y tratamiento precoz de los pacientes infectados, de tal manera a disminuir las complicaciones asociadas a esta patología.

Introduction: Toxoplasmosis is a parasitic disease, in Latin America the prevalence is relatively high, it is known that the disease is not only the most frequent cause of posterior uveitis, but also the main cause of uveitis itself. In Paraguay there are no published epidemiological data on it. Objective: To determine the characteristics of retinal lesions in patients diagnosed with ocular Toxoplasmosis. Methods: This study is observational, descriptive, cross-sectional, temporally retrospective, with non-probabilistic sampling of consecutive cases. It focused on patients diagnosed with Toxoplasmosis who attended the Ophthalmology service of the Hospital de Clínicas, during the period from June 2020 to February 2022. Results: 54.3% of women were observed, an average of 30.62 +/ - 12.96 years old and 62.8% of urban origin. 88.3% of the cases were unilateral, half were primary episodes, 93.6% acute cases, and 97.9% had an acquired transmission mechanism. Most presented as panuveitis, the most frequent locations of retinochoroidal lesions were the posterior pole (extramacular) and the periphery. The main therapeutic approach was treatment with trimethoprim sulfamethoxazole and systemic corticosteroids, the duration of treatment was 6.51 +/- 1.52 weeks, and the main complications were residual vitritis and ocular hypertension. Discussion: Ocular toxoplasmosis is an important cause of visual morbidity. It is essential to prevent infection by this parasite through hygienic-sanitary measures, as well as early diagnosis and treatment of infected patients, in order to reduce the complications associated with this pathology.

Comparación de Latanoprostene bunod 0,024 % y Latanoprost 0,005 % en glaucoma de ángulo abierto e hipertensión ocular

Introducción: El glaucoma es la principal causa de ceguera irreversible en el mundo. La prevalencia mundial de glaucoma en personas de 40 a 80 años se estima en un 3,5 %. Objetivo: Comparar el efecto reductor de la PIO de Latanoprostene bunod (LBN) al 0,024% con Latanoprost al 0,005 % en sujetos con glaucoma de ángulo abierto (GAA) o hipertensión ocular (HTO). Metodología: Ensayo observacional de estudio de cohorte prospectivo. Resultados: Fue realizado en 28 pacientes (56 ojos) quienes fueron aleatorizados en 2 grupos paralelos (28 ojos por grupo), el grupo Latanoprost y el grupo LBN. En el grupo LBN la media de la PIO antes del tratamiento fue de 25,3 ± 6,6 mmHg y la media de la PIO luego de 1 mes de tratamiento fue de 16,5 ± 4,9 mmHg (p<0,05). En el grupo Latanoprost la media de la PIO antes del tratamiento fue de 23,6 ± 3,6 mmHg y la media de la PIO luego de 1 mes de tratamiento con Latanoprost al 0,005% fue de 15,3 ± 2,4 mmHg (p<0,05). Sin embargo, al comparar las PIOs luego de 1 mes de tratamiento con LBN 0,024% y Latanoprost 0,005% se objetiva que la diferencia en reducción de la presión intraocular entre estos dos fármacos no fue significativa (p= 0,238). Discusión: Las prostaglandinas tópicas, con su potente efecto hipotensor ocular son una importante opción de tratamiento para el glaucoma. La reducción de la PIO es la esperada con ambos medicamentos, sin embargo, no existen diferencias significativas entre ambas luego de 1 mes de uso. Con respecto a los efectos secundarios, en el grupo LBN se encontró más efectos adversos oculares.

Introduction: Glaucoma is the main cause of irreversible blindness worldwide. The global prevalence of glaucoma in people aged 40 to 80 years is estimated at 3.5%. Objective: To compare the intraocular pressure (IOP) lowering effect of 0.024% Latanoprostene bunod (LBN) with 0.005% Latanoprost in subjects with open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods: Observational trial of prospective cohort study. Results: It was performed in 28 patients (56 eyes) who were randomized into 2 parallel groups (28 eyes per group), the Latanoprost group and the Latanoprostene bunod (LBN) group. In the LBN group, the mean intraocular pressure before treatment was 25.3 ± 6.6 mmHg and the mean intraocular pressure after 1 month of treatment was 16.5 ± 4.9 mmHg (p<0,05). In the Latanoprost group, the mean intraocular pressure before treatment was 23.6 ± 3.6 mmHg and the mean intraocular pressure after 1 month of treatment with 0.005% Latanoprost was 15.3 ± 2.4 mmHg (p<0,05). However, when comparing the IOPs to the 1-month treatment with Latanoprostene bunod 0.024% and Latanoprost 0.005%, it is observed, through ANOVA, that the difference in intraocular pressure reduction between these two drugs is not significant (p= 0,238). Discussion: Topical prostaglandins, with their potent ocular hypotensive effect (resulting from increased uveoscleral outflow), are an important treatment option for glaucoma. The IOP reduction is as expected with both drugs, however, there are no significant differences between the two. In the LBN group, more drug-related ocular adverse effects were found after 1 month of use.

Delayed-onset pressure-induced interlamellar stromal keratitis (PISK) and interface epithelial ingrowth 10 years after laser-assisted in situ keratomileusis.

Purpose: To report a case of pressure-induced interlamellar stromal keratitis (PISK) 10 years after laser assisted in situ keratomileusis (LASIK). Observations: A case of a 36-year-old man who underwent LASIK and presented with PISK 10 years later. Before presenting to our department he consulted elsewhere for red eye, decreased visual acuity, foreign body sensation, and pain on the RE for 1 week. He was then prescribed topical prednisolone six times per day and was lost to follow-up. On examination and after 1 month of continuous use of steroids uncorrected distance visual acuity (UCDV) was 20/400 in the right eye (RE) and 20/20 in the left eye (LE). Best corrected visual acuity was 20/80 on the RE. The Goldmann intraocular pressure (IOP) was 26 and 17 mmHg in the RE and LE, respectively. Slit lamp biomicroscopy revealed fluid in the interface and epithelial ingrowth. Fundoscopic examination results were normal in both eyes. Treatment was initiated with topical brimonidine tartrate 0.2%, timolol 0.5%, and dorzolamide 2.0% BID. Once the pressure was controlled the patient was scheduled for mechanical debridement of the epithelial ingrowth with significant improvement of UCVA (20/25). Conclusions: Refractive surgeons should be aware of PISK as a potential complication of LASIK even years after the procedure. Intraocular pressure can be misleading, and diligent and careful examination are key to diagnosis and treatment of this potentially blinding complication.

Correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Ángulo Abierto

RESUMEN Introducción: Las estrategias de SITA Estándar fueron aprovechadas por más de dos décadas, pero buscando aun mejorar el tiempo sin perder la calidad, se volvió a crear una nueva estrategia más corta, a la cual llamaron estrategia FASTER. Objetivo: Determinar la correlación entre las estrategias SITA Estándar 24 -2 y SITA Faster 24 -2 para evaluar el daño campimétrico en pacientes con Glaucoma Primario de Angulo Abierto. Metodología: Estudio observacional analítico. RESULTADOS: Se analizó 74 resultados de análisis del campo visual utilizando dos técnicas SITA Estándar 24 - 2 y SITA Faster 24 - 2. El tiempo de prueba para la estrategia SITA Estándar fue de 379,64 ± 72,75 segundos y para la estrategia SITA Faster 170,93 ± 49,17 (p<0,0001), probando una reducción de tiempo del 55% para la segunda. Los valores de desviación media, desviación patrón estándar y el índice de campo visual no mostraron diferencias estadísticamente significativas entre ambas pruebas. La Prueba de Hemicampo de glaucoma con el cálculo del índice Kappa de Cohen arroja un valor de 0,316 con un intervalo de confianza del 95 % de (0,098 - 0,534) lo que indica que es estadísticamente significativo. Discusión: Los resultados generales indican que es posible reemplazar la estrategia SITA Estándar 24 -2 con la estrategia SITA Faster 24 - 2. Este cambio será especialmente útil para aumentar la frecuencia de exámenes campimétricos, determinante para una detección más temprana de la progresión del glaucoma y así mejorar las conductas terapéuticas que se toman con los pacientes que acuden a nuestro servicio.

ABSTRACT Introduction: SITA Standard strategies were used for more than two decades, but still seeking to improve time without losing quality, a new shorter strategy was created again, which they called the FASTER strategy. Objective: To determine the correlation between the SITA Standard 24-2 and SITA Faster 24-2 strategies to evaluate the visual field damage in patients with Primary Open Angle Glaucoma. Methodology: Analytical observational study. Results: 74 visual field analysis results were analyzed using two techniques SITA Standard 24 - 2 and SITA Faster 24 - 2. The test time for the SITA Standard strategy was 379.64 ± 72.75 seconds and for the SITA strategy Faster 170.93 ± 49.17 (p <0.0001), proving a 55% time reduction for the second. The mean deviation, standard deviation and visual field index values do not show statistically significant differences between both tests. The Glaucoma Hemifield Test with the calculation of the Cohen's Kappa index gives a value of 0.316 with a 95% confidence interval of (0.098 - 0.534) which indicates that it is statistically significant. Discussion: The overall results indicate that it is possible to replace the SITA Standard 24-2 strategy with the SITA Faster 24-2 strategy. This change will be especially useful to increase the frequency of campimetric examinations. A greater frequency of examinations is important for earlier detection of glaucoma progression and thus improve the therapeutic behaviors that are taken with the patients who come to our service.