In Vivo Evaluation of Laser-Induced Optical Breakdown (LIOBS) by 1064-nm Nd:YAG Fractional Picosecond Laser With Reflectance Confocal Microscopy and Precise Histopathologic Correlation.

OBJECTIVES: Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV. MATERIALS AND METHODS: This study was performed on six Chilean healthy volunteers, males and females, aged 35-65 years old with Fitzpatrick skin phototypes III-IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded. RESULTS: Every individual developed a 10 mm2 area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis. CONCLUSION: The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.

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.

Visual and satisfaction results with implantation of the trifocal Panoptix® intraocular lens in cataract surgery.

PURPOSE: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens. METHODS: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied. RESULTS: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results. CONCLUSIONS: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses.

Topical interferon alpha-2b for a giant ocular surface squamous neoplasia: 7 years of follow-up after complete remission.

A man with a history of blind eye due to trauma 22 years earlier consulted at 53 years of age with a large conjunctival neoplastic lesion, compromising almost the entire temporal limbus, and reaching a size of approximately 16 mm on its larger diameter, in the conjunctiva. Management was started with topical and subconjunctival chemotherapy (interferon alpha-2b) in order to perform immunoreduction, but a dramatic response with total disappearance of the lesion was observed. In the follow-up time period of more than 7 years, there were no signs of recurrence.

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle. / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.

Hair shaft abnormalities. Pili bifurcati: a scanning electron microscopy analysis.

Pili bifurcati is an extremely rare hair shaft abnormality. We present a case with a scanning electron microscopy analysis.

Massive Hyphaema Following Laser Iridotomy in a Patient on Dual Antiplatelet Therapy (Aspirin plus Ticagrelor): Case report and literature review.

Massive hyphaema presentation after a laser iridotomy is very rare. We report a 63-year-old man with ischaemic heart disease on dual antiplatelet therapy (aspirin plus ticagrelor) who was diagnosed as a primary angle-closure suspect and was to undergo a neodymium-doped yttrium aluminium garnet laser iridotomy at Centro Oftalmológico Virgilio Galvis, Floridablanca, Colombia in 2016. While performing the iridotomy in the left eye, active bleeding occurred that finally filled approximately 75% of the anterior chamber. Intraocular pressure (IOP) increased to 62 mmHg. Mannitol and a topical dorzolamide/timolol were used to control the increase in IOP. The hyphaema slowly resolved over the following week without sequelae. This case revealed that massive hyphaema can complicate laser iridotomy in patients on dual antiplatelet therapy, although this is rare. Therefore, if patients are taking aspirin and ticagrelor, it would be advisable to stop the second medication if possible. In addition, sequential application of photocoagulation and photodisruption lasers might diminish the risk of significant bleeding.

Severe pigment dispersion after iris-claw phakic intraocular lens implantation.

A 23-year-old female patient presented 3 months after the implantation of an Artisan® phakic intraocular lens with a severe depigmentation of the iris and peripheral anterior synechiae. Explantation of the intraocular lens and goniosynechialysis were performed. Eleven months after the explantation appearance of the iris significantly improved. There was no loss of lines of corrected distance visual acuity. Severe pigment dispersion after the implantation of an Artisan® phakic intraocular lens may happen and may require explantation of the lens. Iris depigmentation may improve with time.

Visual and satisfaction results with implantation of the trifocal Panoptix (R) intraocular lens in cataract surgery

Purpose: To assess visual results (including the Lapid-Kushlin defocus coefficient), and satisfaction, following the implantation of PanOptix® a trifocal intraocular lens.Methods: Observational, retrospective cohort study. 130 eyes of 65 subjects with bilateral implantation were included. Binocular uncorrected visual acuities [distance (Binocular UDVA), intermediate (Binocular UIVA) and near (Binocular UNVA)] were measured. Also, the manifest refraction, binocular defocus curve and binocular contrast sensitivity were determined. The Lapid-Kushlin defocus coefficient, a new single numerical parameter based on the area under the curve of the defocus curve, was calculated. The validated Spanish CATQUEST-9SF satisfaction survey was applied.Results: Postoperative visual acuity ranges were: binocular UDVA 0.18 to 0.0 LogMAR, binocular UIVA 0.30 to 0.0 LogMAR and Binocular UNVA 0.18 to 0.0 LogMAR. The levels of contrast sensitivity both in bright light conditions (with and without glare) and low light conditions with glare, remained within the limits of normality. Under scotopic conditions without glare values below normality were found at lower spatial frequencies. The binocular defocus curve showed a plateau without a clearly evident peak. The Lapid-Kushlin defocus coefficient was 0.199. Two patients (3.1%) needed glasses after the procedure for near and intermediate vision. No patient manifested great visual difficulties or was dissatisfied with the results.Conclusions: The trifocal platform showed very good results in this series of patients. 96.9% of the patients achieved independence of the glasses and expressed a high degree of satisfaction. The Lapid-Kushlin defocus coefficient was better than those calculated from literature, for other multifocal intraocular lenses. (AU)

Corneal Cross-Linking (with a Partial Deepithelization) in Keratoconus with Five Years of Follow-Up.

We performed a retrospective interventional case series including 80 eyes of 48 patients with keratoconus (KC) who were treated with modified corneal cross-linking (CXL) for KC (with a partial deepithelization in a pattern of stripes). The average follow-up was 5.8 years (with a minimum of 5 years). At the last follow-up visit, compared with preoperative values, there were no significant changes in spherical equivalent, average keratometry, corneal thickness, corneal hysteresis, or corneal resistance factor. The distance-corrected visual acuity was 20/39 preoperatively and 20/36 postoperatively (P = 0.3). The endothelial cell count decreased by 4.7% (P < 0.005). These findings suggest that this modified corneal CXL technique is a safe and effective alternative to halt the progression of KC up to five years after the procedure. However, some concerns remain as to whether this technique can affect in some degree the corneal endothelial cells.

Severe corneal burn due to the accidental application of salicylic acid packed in a plastic dropper bottle / Quemadura corneal grave debida a la aplicación accidental de ácido salicílico envasado en un frasco gotero plástico

Eye burns due to the accidental application of pharmacological or nonpharmacological substances packaged in plastic dropper bottles have been described for more than three decades and continue to occur. These burns can cause potentially serious corneal injuries. We report the case of a patient who mistakenly applied salicylic acid to the right eye after confusing it with an eye lubricant, which caused him a severe corneal burn. Fortunately, after aggressive medical and surgical management (including oxygen therapy and amniotic membrane grafting), the visual results were good. We suggest conducting educational campaigns and taking legislative measures in our country to avoid packaging corrosive substances in this type of dropper bottle to reduce the risk of accidental burns.

Las quemaduras oculares por aplicación accidental de sustancias farmacológicas o no farmacológicas envasadas en frascos goteros plásticos, se han descrito desde hace más de tres décadas y siguen ocurriendo. Estas quemaduras pueden causar lesiones potencialmente graves de la córnea. Se presenta el caso de un paciente que se aplicó ácido salicílico en el ojo derecho al confundir el envase con el de un lubricante ocular, lo que le causó una grave quemadura corneal. Afortunadamente, tras un manejo médico y quirúrgico agresivo (incluida oxigenoterapia e injerto de membrana amniótica) los resultados visuales fueron buenos. Se sugiere hacer campañas educativas y adoptar normas en el país para evitar el envase de sustancias corrosivas en este tipo de frascos goteros, con el fin de disminuir el riesgo de quemaduras accidentales.