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Introduction: Herpes Simplex Virus (HSV) is a human herpesvirus responsible for systemic infections. Ocular involvement spans all ocular tissues. Corneal lesions, such as dendritic or geographic ulcers, are frequently found in HSV keratitis while conjunctival lesions have been described as infrequent. Clinical case: A 62-year-old man diagnosed with Birdshot chorioretinopathy presented a stye in his eyelid that was treated with oxytetracycline-hydrocortisone ointment. One week later he returned presenting several small dendritic corneal ulcers in both eyes and a conjunctival ulcer in one of them. All lesions healed completely after treatment with topical acyclovir ophthalmic ointment at 3%. Conclusions: We should pay attention to the conjunctiva and not merely focus on the cornea when examining patients with herpetic eye disease, especially if being treated with inmunosupressors.

Introduction: Retained subretinal perfluoro-n-octane droplets occur in nearly 1% of the procedures. When subretinal cystoid cavities are registered, differential diagnosis including this condition is needed. Clinical case: A 77-year-old male presented three small bubbles of perfluoro-n-octane under the papillomacular bundle after vitrectomy due to a retina redetachment, evidenced by multimodal image. Conclusions: Multimodal image can help to diagnose this condition. There are several signs that can support this diagnosis. If visual acuity is threatened, removing the bubbles is mandatory, accepting risks.

ObjectivesReverse transcriptase PCR (RT-PCR) is considered the gold standard in diagnosing COVID-19. Infected healthcare workers do not go back to work until RT-PCR has demonstrated that the virus is no longer present in the upper respiratory tract. The aim of this study is to determine the most efficient time to perform RT-PCR prior to healthcare workers’ reincorporation.Materials and methodsThis is a cohort study of healthcare workers with RT-PCR-confirmed COVID-19. Data were collected using the medical charts of healthcare workers and completed with a telephone interview. Kaplan-Meier curves were used to determine the influence of several variables on the time to RT-PCR negativisation. The impact of the variables on survival was assessed using the Breslow test. A Cox regression model was developed including the associated variables.Results159 subjects with a positive RT-PCR out of 374 workers with suspected COVID-19 were included. The median time to negativisation was 25 days from symptom onset (IQR 20–35 days). Presence of IgG, dyspnoea, cough and throat pain were associated with significant longer time to negativisation. Cox logistic regression was used to adjust for confounding variables. Only dyspnoea and cough remained in the model as significant determinants of prolonged negativisation time. Adjusted HRs were 0.68 (0.48–096) for dyspnoea and 0.61 (0.42–0.88) for dry cough.ConclusionsRT-PCR during the first 3 weeks leads to a high percentage of positive results. In the presence of respiratory symptoms, negativisation took nearly 1 week more. Those who developed antibodies needed longer time to negativisate.

Purpose: The presence of the so called disc at risk (a small disc with no cupping) has been considered the main risk factor for the development of non-arteritic anterior ischemic optic neuropathy (NAION). However its role as a prognostic factor has not been studied. Our aim was to determine the weight of disc configuration as a risk and a prognostic factor for NAION. Methods: Case control study. Forty eyes of 40 patients who were diagnosed with NAION between 2008 and 2017, and 120 controls (3 controls for each patient) were included in the study. Disc diameter (DD), cup to disc ratio (CDR), and peripapillar retinal nerve fiber layer thickness (RNFLT) of the non-affected eye were measured using optic coherence tomography (3D OCT 2000, Topcon). Crowding index (CI) was defined as the quotient of average RNFLT and disc area. Mean deviation (MD) at the time of diagnosis and at least three months later was determined using a Humphrey Visual Field Analyzer (SITA standard 24-2 strategy). Visual acuity (VA) was measured using Snellen charts and transformed into LogMAR values. Results: Only CDR was found to be a risk factor for NAION. No correlationship was found between CI and visual loss. Conclusions: DD and CI did not show value as either prognostic or risk factors. Glial tissue may be a part of the content of the optic disc as important as axons. Our results are in line with the latest studies about NAION pathophysiology. Contrary to classic thinking, these papers have not found smaller disc diameters, but smaller values of lamina cribosa depth in NAION patients. pre-print 267 KB

Purpose To describe an easy and effective surgical technique for removing the endocapsular tension ring (CTR) after phacoemulsification. Design New surgical technique. Methods One 10-0 polypropylene suture needle is passed through the hole at one end of the CTR. Then, the CTR is introduced into the capsular bag before phacoemulsification. If the posterior capsule ruptures, the CTR can be removed by pulling the suture toward the corneal incision and rotating the CTR to remove it. Results We performed this technique in 23 cases with a risk of zonular damage and did not encounter complications at any point in the procedure. Conclusions We recommend this procedure in eyes with risk of zonular dialysis and posterior capsule rupture, especially in advanced pseudoexfoliative cataracts or if the surgeon has limited experience with these cases.

An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Corneal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic–capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.

PURPOSE To compare the intraocular pressure (IOP) measurements obtained with the rebound tonometer (RT) and the Goldmann handheld tonometer (GT) in normal and altered corneas. METHODS A total of 208 normal corneas and 50 corneas with pathologies were included in this prospective study. All measurements were randomly obtained by 1 observer. The medians and interquartile range (IR) for both tonometers were compared. The median differences were assessed in IOP groups. Agreement between the tonometers was calculated using the Bland-Altman method. RESULTS The median IOP in all eyes was 17 mm Hg (IR, 13-22 mm Hg) with the RT and 16 mm Hg (IR, 13-21 mm Hg) with the GT (P < 0.001). The correlation was excellent between tonometers (r2 = 0.86; P < 0.001). The minimal differences between the two were obtained from 10 to 20 mm Hg (GT). The Bland-Altman scatterplot obtained good agreement between the instruments. In normal corneas, the median difference was < or =2 mm Hg in 77.4% of cases. In the altered corneas, the median difference was < or =2 mm Hg in 73% of cases (P = 0.21 compared with the normal group). In 10% and 2% of cases, the IOP could not be measured using the GT and RT, respectively. CONCLUSIONS The results were similar for both tonometers. In the altered corneas, the IOP could be difficult to obtain with the GT because of distorted half-circles. The 1-mm-diameter disposable RT tip facilitated obtaining measurements without anesthetic drops, which avoids infections. The RT could be useful in routine clinical settings when measuring IOP in corneas with pathologies.

We describe a surgical technique for managing late dislocation of an intraocular lens-capsular bag-capsular tension ring (IOL-CB-CTR) complex. Two 10-0 polypropylene sutures are placed transsclerally over and under the CTR through the anterior and posterior capsules to capture the CTR, which then is retracted and sutured through the sclera. The same maneuver is performed 180 degrees away. This simple, easy, effective procedure can be performed with a small corneal incision and does not require extraction of the IOL-CB complex. Although the CTR does not completely prevent IOL-CB dislocation, it provides the possibility of suturing the IOL-CB to the sulcus without replacing the IOL.

Purpose To assess the frequency of glistenings in eyes that had phacoemulsification and implantation of AcrySof intraocular lenses (IOLs) (Alcon) and to evaluate the clinical factors related to the glistenings. Setting Departamento de Oftalmologia, Clinica Universitaria, Universidad de Navarra, Pamplona, Spain. Methods A consecutive series of 129 eyes of 94 patients was prospectively evaluated. All patients had cataract surgery and implantation of an MA30BA AcrySof IOL by the same surgeon using the same technique. The operating surgeon examined patients for the presence of glistenings. The frequency and intensity of glistenings were assessed in relation to 14 clinical factors. The effect of glistenings on postoperative Snellen best corrected visual acuity (BCVA) was also evaluated. Results Glistenings, which occurred in 38 cases (29.5%), were slight in 15 eyes, moderate in 18, and intense in 5. The frequency of the glistenings was related to the time between surgery and evaluation ( P = .0001), the IOL dioptric power ( P = .01), postoperative inflammation ( P = .01), and phacotrabeculectomy ( P = .01). The intensity of the glistenings was related to the time after surgery ( P = .01) and presence of postoperative inflammation ( P = .004). No relation between glistenings and Snellen BCVA was found. Conclusions The frequency and intensity of glistenings in AcrySof IOLs increased with time after surgery and were higher when postoperative inflammation was present. Glistenings developed more frequently in cases of phacotrabeculectomy but not after combined phacoemulsification and deep sclerectomy. Glistenings did not result in decreased Snellen BCVA.