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Purpose To determine which nocturnal blood pressure (BP) parameters (low levels or extreme dipper status) are associated with an increased risk of glaucomatous damage in Hispanics. Design Observational cross-sectional study. Participants A subset (n = 93) of the participants from the Maracaibo Aging Study (MAS) who met the study eligibility criteria were included. These participants, who were at least 40 years of age, had measurements for optical tomography coherence, visual field (VF) tests, 24-hour BP, office BP, and intraocular pressure Methods Univariate and multivariate logistic regression analyses under the generalized estimating equations (GEE) framework were used to examine the relationships between glaucomatous damage and BP parameters, with particular attention to decreases in nocturnal BP. Main Outcome Measures Glaucomatous optic neuropathy (GON) based on the presence of optic nerve damage and VF defects. Results The mean age was 61.9 years, and 87.1% were women. Of 185 eyes evaluated, 19 (26.5%) had signs of GON. Individuals with GON had significantly lower 24-hour and nighttime diastolic BP levels than those without. However, results of the multivariate GEE models indicated that the glaucomatous damage was not related to the average systolic or diastolic BP levels measured over 24 hours, daytime, or nighttime. In contrast, extreme decreases in nighttime systolic and diastolic BP (>20% compared with daytime BP) were significant risk factors for glaucomatous damage (odds ratio, 19.78 and 5.55, respectively). Conclusions In this population, the link between nocturnal BP and GON is determined by extreme dipping effects rather than low nocturnal BP levels alone. Further studies considering extreme decreases in nocturnal BP in individuals at high risk of glaucoma are warranted.

Purpose To report the use of anterior lens capsule flap transplantation in two cases with chronic full-thickness macular hole (MH). Methods Case series. Results Two cases of chronic MH with a new treatment approach were reported. In the first case, a 66-year-old man presented with a chronic idiopathic MH in the left eye for 2 years. Presenting visual acuity was hand motion. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. At 5 months postoperatively, the visual acuity was 20/200 with MH closure. In the second case, a 68-year-old woman presented with decreased visual acuity for 2 years. Her visual acuity was hand motion in the right eye. The patient underwent phacoemulsification and vitrectomy with anterior lens capsule flap transplantation in the MH. Visual acuity improved to 20/400 with reduction in the MH diameter. Vision and MH diameter remained stable over 5 months postoperatively. Conclusion Lens capsular flap transplantation is useful in closing chronic MH in the short term.

Purpose To compare surgeon experience and the outcomes of phacoemulsification using 2 different illumination techniques for cataract extraction. Methods A prospective interventional case series was performed on 20 consecutive patients (20 eyes) with senile cataract who underwent phacoemulsification enhanced with a 23-G endoillumination probe. The main outcome measures were the surgeon's perception of depth of field and quality of visibility of intraocular structures, ease of performance of the surgical procedure, effectiveness, and complications related to the procedure. A surgeon-specific questionnaire was administered at the end of the procedure. Results Surgery was successfully performed in all patients without any complications. The surgeon indicated that lateral endoillumination markedly enhanced the details of the lens structures, mainly the posterior capsule visualization, better than the coaxial lighting with the surgical microscope. Lateral endoillumination created an enhanced 3D effect and improved the depth perception of lens intraoperatively. Conclusions The lateral illumination technique with a 23-G endoilluminator probe placed in the anterior chamber through a paracentesis creates an enhanced 3D effect and improves depth perception of lens during phacoemulsification. These benefits increase the safety of the procedure.

To report the use of intravitreal triamcinolone for Susac Syndrome in one patient. Case report. A 23-year-old woman presented with presented with sudden visual loss in the left eye with associated neurologic symptoms. Ophthalmic examination and fluorescein angiography showed multiple areas of branch retinal artery occlusion, bilaterally. Magnetic resonance imaging showed dot-like, diffusion-restricted lesions in the corpus callosum, and audiometry showed low-frequency sensory hearing loss, compatible with Susac Syndrome. The patient received a single intravitreal injection of triamcinolone (4 mg) in the left eye. One week later, before beginning systemic corticosteroids, all signs and symptoms resolved in the left eye only. In cases of delayed systemic corticosteroid therapy, intravitreal triamcinolone resolves the ocular manifestations of Susac Syndrome.

* BACKGROUND AND OBJECTIVE: To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens implantation combined with our modified 2-port pars plana vitrectomy technique (phacovitrectomy). * PATIENTS AND METHODS: Phacovitrectomy using topical anesthesia (4% lidocaine drops) was prospectively performed in 105 eyes with cataract and varied vitreoretinal pathology. In 75 eyes (71.4%), phacovitrectomy was combined with argon laser photocoagulation (endolaser). Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). * RESULTS: All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. No patient required additional retrobulbar, peribulbar, or sub-Tenon's anesthesia. * CONCLUSION: This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacovitrectomy. [Ophthalmic Surg Lasers 2002;33:293-297]

Importance The ocular manifestations and sequelae of Zika virus infection are not well known. Recently, the World Health Organization changed the declaration of Zika as a public health emergency and designated the viral outbreak and related microcephaly clusters as a long-term program of work. This change indicates the urgent need to evaluate and document ophthalmic manifestations in patients for timely management of this disease. In addition, confirmation whether the public health problem in Brazil extends to other regions in South America is needed. Objective To report the ocular manifestations of congenital Zika syndrome with microcephaly in Colombia and Venezuela. Design, Setting, and Participants This prospective case series included 43 patients from 2 ophthalmic centers in Colombia and Venezuela who underwent evaluation from October 1, 2015, through June 30, 2016, and were clinically diagnosed with congenital Zika syndrome. Twenty patients were Hispanic; 13, African; 8, white; and 2, Native American. Interventions Ophthalmic and systemic evaluations and serologic testing were performed on all infants. Patients underwent external ocular examination and dilated ophthalmoscopy. Serologic testing ruled out toxoplasmosis, rubella, cytomegalovirus, syphilis, and human immunodeficiency virus. Main Outcomes and Measures Ophthalmic manifestations of congenital Zika syndrome. Results Of the 43 patients included in this series (28 female and 15 male), the mean (SD) age at examination was 2.1 (1.5) months. The mothers of all the children had no ophthalmic findings and did not report ocular symptoms during pregnancy. All patients had bilateral ophthalmic manifestations. Optic nerve findings included hypoplasia with the double-ring sign, pallor, and increased cup-disc ratio in 5 patients (11.6%). Macular abnormalities included mild to severe pigment mottling in 27 patients (63%) and lacunar maculopathy in 3 (6.9%). Chorioretinal scarring was present in 3 patients (7%). Eleven patients (26%) had a combination of lesions in the posterior pole. Five patients (12%) were diagnosed with congenital glaucoma, characterized by the clinical triad of epiphora, photophobia, and blepharospasm; increased intraocular pressure; corneal clouding at birth; and buphthalmos. These data reveal that 12% (95% CI, 5%-24%) of cases of congenital Zika with microcephaly had anterior segment abnormalities and 88% (95% CI, 76%-94%) had important macular and optic nerve abnormalities. The visual sequelae of these ophthalmic manifestations remain unknown. Conclusions and Relevance Congenital Zika syndrome in the current study had severe ocular abnormalities, and all patients had bilateral involvement. Ocular findings were focal macular pigment mottling, chorioretinal atrophy with a predilection for the macular area, congenital glaucoma and optical nerve hypoplasia, and optic disc abnormalities. Ophthalmic examination is recommended in patients with congenital Zika syndrome.

Purpose To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens (IOL) implantation combined with pars plana vitrectomy. Setting Clinica de Ojos de Maracaibo, Maracaibo, and the Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. Methods In this prospective study, phacoemulsification, IOL implantation, and posterior vitrectomy using topical anesthesia (lidocaine 4% drops) were prospectively performed in 45 eyes (45 patients) with varied vitreoretinal pathology including macular holes, epiretinal membranes, subfoveal neovascular membranes, proliferative diabetic retinopathy, and vitreous hemorrhage. Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort). Results All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. The mean amount of lidocaine 4% drops required during each procedure was 0.5 mL. No patient required additional retrobulbar, peribulbar, or sub-Tenon’s anesthesia. Conclusions This technique avoids the risks of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye at a lower cost. With appropriate case selection, topical anesthesia was a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and IOL implantation combined with posterior 3-port pars plana vitrectomy.

The safety and efficacy of a modified technique for transscleral fixation of a foldable posterior chamber intraocular lens (IOL) for intracapsular aphakia (secondary IOL) or after complicated phacoemulsification was evaluated. All eyes had inadequate or no posterior capsular support. Follow-up was between 4 and 26 months (mean, 12 months). Uncorrected visual acuity improved (> 2 lines) in all patients. During follow-up, the IOL was correctly positioned in all cases. There were no major complications, such as endophthalmitis or suture erosion through the conjunctiva at the site of fixation. No patient required further surgical interventions. This modified technique of transscleral fixation of foldable posterior chamber IOL offers the advantages of a small incision and rapid visual rehabilitation, and minimizes the risk of intraoperative and postoperative complications. [Ophthalmic Surg Lasers Imaging 2006;37:247-250.] AUTHORS From the Retina and Vitreous Service (JBY, JCY, AV), Clinica de Ojos de Maracaibo, Maracaibo; and the Retina and Vitreous Service (JFA), Clinica Oftalmologica Centro Caracas, Caracas, Venezuela. Accepted for publication December 7, 2005. Presented in part at the 19th Annual Meeting of the Vitreous Society, Fajardo, Puerto Rico, November 26-December 1, 2001. Supported in part by the Fundacion Arevalo-Coutinho para la Investigacion en Oftalmologia, Caracas, Venezuela. Address reprint requests to J. Fernando Arevalo, MD, FACS, Clinica Oftalmologica Centro Caracas, Centro Caracas PH-1, Av. Panteon, San Bernardino, Caracas 1010, Venezuela.

Drainage of subretinal fluid is probably the most dangerous step in scleral buckling surgery for uncomplicated retinal detachment. The most common complications include subretinal haemorrhage, retinal perforation, and vitreoretinal incarceration.1,2 Sclerotomy to drain subretinal fluid is traditionally made with a sharp blade, diathermy to the sclera and choroid is performed, followed by perforation of the choroid to allow drainage of subretinal fluid. Suture of the sclerotomy at the end of the procedure has been recommended to avoid retinal incarceration. The purpose of this study was to determine the effectiveness and safety of a modified self sealing sclerotomy technique for drainage of subretinal fluid during scleral buckling surgery. Twenty consecutive patients undergoing scleral buckling for primary rhegmatogenous retinal detachment from two vitreoretinal surgery centres were enrolled in this prospective study. A scleral buckling procedure was …

We describe a new surgical technique, intraoperative peripheral anterior capsulotomy (IPAC), to prevent early postoperative capsular block syndrome (CBS). Eighty consecutive patients (80 eyes) had phacoemulsification and intraocular lens implantation with IPAC in the presence of a small (4.5 to 5.0 mm) anterior continuous curvilinear capsulorhexis (CCC). Patients were followed for a mean of 16 months (range 6 to 24 months), and none developed CBS or other complications. Our series suggests that IPAC may be an alternative to prevent CBS in high-risk eyes, including those with a small anterior CCC or ophthalmic viscosurgical device material trapped in the capsular bag. This surgical technique is safe, effective, inexpensive, and easy to perform.

To evaluate the efficacy of topical anesthesia as an alternative to peribulbar or retrobulbar anesthesia in phacoemulsification and intraocular lens implantation combined with our modified 2-port pars plana vitrectomy technique (phacovitrectomy).Phacovitrectomy using topical anesthesia (4% lidocaine drops) was prospectively performed in 105 eyes with cataract and varied vitreoretinal pathology. In 75 eyes (71.4%), phacovitrectomy was combined with argon laser photocoagulation (endolaser). Preoperative and intraoperative sedation of varying degrees was necessary. Subjective pain and discomfort were graded from 1 (no pain or discomfort) to 4 (severe pain and discomfort).All patients had grade 1 pain and discomfort during most of the procedure. All patients had grade 2 (mild) pain and discomfort during pars plana sclerotomies, external bipolar cautery, and conjunctival closure. No patient required additional retrobulbar, peribulbar, or sub-Tenon's anesthesia.This technique avoids the risk of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye. With appropriate case selection, topical anesthesia is a safe and effective alternative to peribulbar or retrobulbar anesthesia in phacovitrectomy.

PURPOSE: To report the characteristics and surgical outcomes of rhegmatogenous retinal detachments in myopic eyes after laser in situ keratomileusis (LASIK). METHODS: Clinical charts of patients that developed rhegmatogenous retinal detachment after LASIK were reviewed. Surgery to repair rhegmatogenous retinal detachment was performed in 31 eyes (mean follow-up of 14 months after vitreoretinal surgery). RESULTS: A total of 38,823 eyes underwent surgical correction of myopia from -0.75 to -29.00 D (mean -6.00 D). Thirty-three eyes (27 patients; frequency .08%) developed rhegmatogenous retinal detachment after LASLK; detachments occurred between 12 days and 60 months (mean 16.3 mo) after LASIK. Eyes that developed a rhegmatogenous retinal detachment had a mean -8.75 D before LASLK. Most rhegmatogenous retinal detachment and retinal breaks occurred in the temporal quadrants (71.1%). Final best spectacle-corrected visual acuity (BSCVA) of 20/40 or better was obtained in 38.7% of the 31 eyes (two patients refused surgery). Poor final visual acuity (20/200 or worse) occurred in 22.6% of eyes. Information regarding visual acuity after LASIK and before the development of rhegmatogenous retinal detachment was available in 24 eyes; 45.8% (11/24 eyes) lost two or more lines of visual acuity after vitreo-retinal surgery. Reasons for poor visual acuity included the development of proliferative vitreo-retinopathy (n=5), epiretinal membrane (n=1), chronicity of rhegmatogenous retinal detachment (n=1), new breaks (n=1), displaced corneal flap (n=1), and cataract. CONCLUSIONS: Rhegmatogenous retinal detachment after LASLK for myopia is a serious complication. Final visual acuity may be limited by myopic degeneration, amblyopia, or delayed surgical repair. [J Refract Surg 2002;18:708-714]