Search

Purpose To evaluate whether the use of masks has an effect on the measurement of corneal topographic parameters. Methods A study including healthy patients with no previous ocular diseases or surgeries was conducted. Corneal topography was evaluated with an elevation topography Pentacam Scheimpflug. Four measurements were taken: two measurements with face mask and another two measurements after 10 min without wearing the face mask. The following parameters were evaluated: anterior topographic flat meridian (K1), anterior topographic steepest meridian (K2), mean keratometry (Km) and maximum keratometric point (Kmax). Results Thirty-five eyes of thirty-five healthy individuals were included; with a mean age of 33.5 ± 13.8 years (range 24–66) and 26 (74%) being female. Mean time with face-mask was 3.8 ± 2.2 h (range 1–8). No differences in mean K1, K2, Km and Kmax with and without face-mask were noted (paired t-test, all, p > 0.05). Intraclass correlation coefficients (ICC) were excellent for all four analyzed parameters (ICC > 0.914), although they were lower when measurements with face-mask were considered. Conclusions Although tear film alterations with the use of face-mask have been described in the literature, no significant differences can be noted in topographic variables.

The purpose of this study was to report the clinical outcomes of postoperative repositioning of 2 inverted Descemet membrane endothelial keratoplasty (DMEK) grafts in 2 patients with endothelial dysfunction.Two patients underwent DMEK surgery in a tertiary referral corneal clinic. Initial surgery was performed by 2 different corneal surgeons, and a third surgeon repositioned both cases. In the early postoperative period, partial and subtotal detachments were observed at slitlamp and inverted graft orientation was confirmed by anterior segment optical coherence tomography. In both cases, uneventful reposition of the inverted graft was performed by an experienced DMEK surgeon on days 2 and 9 after initial DMEK surgery.Repositioning surgery was successful in both patients. The Moutsouris sign was used to confirm proper orientation. One patient had total graft adherence at day 1 postrepositioning. The second patient required a rebubbling procedure, despite the correct orientation confirmed by using anterior segment optical coherence tomography. Visual acuity and corneal thickness were stable in both cases (case 1: 20/30, 567 μm; case 2: 20/80, 543 μm). Both patients had clear corneas and functional cell counts 2 years after repositioning (451 cells/mm 2 and 1052 cells/mm 2 ).Postoperative repositioning of an inverted DMEK graft may be a viable procedure to delay or prevent regrafting.

In the COVID-19 period, face masks increased exponentially. Several studies suggest that the rise in ocular discomfort symptoms during the pandemic is mostly part of dry eye disease and that these are due to the effect of face masks, resulting in the newly described term MADE, for "mask-associated dry eye". The most commonly proposed mechanism states that wearing a face mask creates an unnatural upward airflow towards the ocular surface during expiration, although the increased temperature, humidity and levels of carbon dioxide of the exhaled air, stress, increased use of video display terminals, as well as changes in the ocular microbiota may contribute. Evidence supports that the use of face masks causes an increase in dry eye disease symptoms, a decreased tear break-up time, corneal epithelial trauma, periocular temperature changes and inflammatory markers secretion. Given that the use of masks may be frequent in some settings in the near future, it is important to establish its effects and consequences on the ocular surface.

Purpose: To describe the clinical and epidemiological characteristics of patients with Vogt-Koyanagi-Harada (VKH) disease in Spain. Methods: This was a retrospective multicenter analysis of data from VKH patients followed for at least 6 months. The data collected were related to demographics, clinical manifestations, treatments, and complications. Results: Participants were 112 patients (224 eyes), from 13 tertiary referral centers, of mean age 37.5 ± 14.7 years; 83.9% were women. Ethnicities were 61.6% Caucasian and 30.4% Hispanic. The disease was classified as complete in 16.1%, incomplete in 55.4%, and probable in 28.6%. When seen for the first time, the clinical course was acute in 69.6%, recurrent chronic in 15.2%, and chronic in 14.3%. The most frequent treatment was corticosteroids (acute stage 42.2%, maintenance stage 55.6%). The most common complications were cataract (41.1%) and ocular hypertension (16.1%). In most eyes, visual acuity was improved (96.7%) or remained stable at the end of follow up. Conclusion: VKH in Spain mostly affects women and presents as incomplete acute stage disease. Visual prognosis is good. Cataract and glaucoma are the two most frequent complications.

Summary Objective To assess safety and efficacy of corneal collagen crosslinking (CXL) for advanced bullous keratopathy (BK). Material and methods Eight eyes of eight patients subjected to Dresden CXL protocol. Inclusion criteria: BK history of at least one year, severe pain and no indication for keratoplasty due to poor visual prognosis. Variables: best corrected visual acuity (BCVA), pain (decimal visual scale), central corneal thickness (CCT) by tomography (Pentacam®, Oculus Inc, Germany), corneal bullae and complications. Results Seven women and one man of median age 77.00 (range 58–79) years. The median follow-up was 7 (range 5–7) months. BCVA remained unchanged through follow-up. A significant decrease in pain was observed at the end of the follow-up period (median 6, range 5–6 vs. median 0, range 0–4, P = 0.05). Corneal tomography could only be performed in three cases, due to poor vision or image quality. A reduction in mean CCT was observed in the first post procedural month (from 708.33 ± 140.48 to 627 ± 136.89 μm). In all eight cases, the absence of corneal bullae only persisted for two months after CXL. In six patients, corneal re-epithelialization after CXL was poor; in four of these eyes, the problem was resolved with topical treatment, but in the remaining two eyes, amniotic membrane transplant and mechanical debridement were required. Conclusions In this uncontrolled small case series, CXL treatment improved pain in patients with advanced BK. However, the high rate of poor re-epithelialization requiring surgical treatment observed in one third of cases makes this treatment controversial.

Background: Series of patients with SARS‐CoV‐2 infection report headache in 6%‐15% of cases, although some data suggest that the actual frequency is higher, and that headache is not associated with fever. No study published to date has analyzed the characteristics of headache in these patients. Objective: To analyze the characteristics of COVID‐19 related headaches. Methods: We conducted a survey of Spaniard healthcare professionals who have been infected by SARS‐CoV‐2 and presented headache during the course of the disease. The survey addressed respondents’ medical history and headache characteristics, and we analyzed the association between both. Results: We analyzed the responses of a sample of 112 healthcare professionals. History of migraine was reported by 20/112 (17.9%) of respondents, history of tension‐type headache by 8/112 (7.1%), and history of cluster headache was reported by a single respondent; 82/112(73.2%) of respondents had no history of headache. Headache presented independently of fever, around the third day after symptom onset. The previous history of migraine was associated with a higher frequency of pulsating headache (20% in patients with previous migraine vs 4.3% in those with no history of migraine, P = .013). Conclusion: Headache is often holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Because the characteristics of the headache and the associated symptoms are heterogeneous in our survey, we suggest that several patterns with specific pathophysiological mechanisms may underlie the headache associated with COVID‐19.

The main purpose of this study is to evaluate the presence of viral RNA of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in conjunctival swab specimen of coronavirus disease 2019 (COVID‐19) patients with and without conjunctivitis to establish the diagnostic value of reverse transcription‐polymerase chain reaction (RT‐PCR) in each case and to describe its clinical characteristics. A cross‐sectional study was conducted at the Hospital Clinico San Carlos of Madrid, Spain. Thirty‐six subjects from the COVID admission unit with laboratory‐confirmed SARS‐CoV‐2 infection were included. Conjunctival swabs were collected from 18 patients with conjunctivitis and 18 patients without conjunctivitis and RT‐PCR was performed. Conjunctival swab was collected from both eyes of 36 patients (72 eyes), detecting SARS‐CoV‐2 RNA in conjunctival swab of two patients (5.5%). Among the 18 patients with conjunctivitis, only one of them (5.5%) showed positive results. Likewise, SARS‐CoV‐2 RNA was detected in one patient without conjunctivitis (5.5%). The mean age of the 36 patients was 67.9 years (range, 28‐92 years) and the male‐to‐female ratio was 0.44 (16:20). The mean days since the onset of COVID‐19 symptoms until conjunctivitis manifestation was 8 (range, 1‐24 days). The mean duration of the conjunctivitis was 3 days (range, 1‐7 days). SARS‐CoV‐2 RNA may be detected in conjunctival swabs of both patients with and without conjunctivitis. This study revealed the same rate of positive results amongst the group with and without conjunctivitis, suggesting that detecting SARS‐CoV‐2 in ocular fluids is not conditioned on the presence of conjunctivitis. The presence of SARS‐CoV‐2 RNA in ocular samples highlights the role of the eye as a possible route of transmission of the disease., Highlights SARS‐CoV‐2 RNA can be detected in conjunctival secretions of both patients with and without conjunctivitis. However, PCR essay of tears and conjunctival secretions appear to have a fairly low potential of detecting the virus.

Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis. RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

This review has identified evidence about pseudomyopia as the result of an increase in ocular refractive power due to an overstimulation of the eye’s accommodative mechanism. It cannot be confused with the term “secondary myopia”, which includes transient myopic shifts caused by lenticular refractive index changes and myopia associated with systemic syndromes. The aim was to synthesize the literature on qualitative evidence about pseudomyopia in terms that clarify its pathophysiology, clinical presentation, assessment and diagnosis and treatment. A comprehensive literature search of PubMed and the Scopus database was carried out for articles published up to November 2021, without a data limit. This review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Following inclusion and exclusion criteria, a total of 54 studies were included in the qualitative synthesis. The terms pseudomyopia and accommodation spasm have been found in most of the studies reviewed. The review has warned that although there is agreement on the assessment and diagnosis of the condition, there is no consensus on its management, and the literature describes a range of treatment.

IMPORTANCE To provide a normative vessel density (VD) database for the macula through swept-source optical coherence tomography angiography (OCTA) and to assess the main determinants of this measurement. BACKGROUND In contrast with dye angiography, the recently introduced OCTA technique allows for the non-invasive measurement of retinal and choroidal VD metrics. DESIGN Cross-sectional study. PARTICIPANTS The right eyes of 346 healthy subjects were studied. In 105 subjects both eyes were imaged. METHODS Foveal and parafoveal macular VD measurements were obtained in the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and in the choriocapillaris (CC) layer. Also recorded were age, sex, axial length (AL), foveal and choroidal thickness (CT). MAIN OUTCOME MEASURES Normative database and determinants of macular VD measured by OCTA. RESULTS Mean participant age was 38.3 ± 20.1 years (mean ± SD) (range 5-83). Foveal VDs in the different plexuses were: SCP 22.1% ± 5.0% (7.3-35.1), DCP 19.9% ± 6.3% (6.9-51.2) and CC: 52.8% ± 4.3% (40.2-62.1). Parafoveal VDs ranged from 45.4% ± 3.7% to 51.8% ± 4.6%. Positive correlation was observed between foveal VD and foveal thickness (R = .327), as well as between parafoveal DCP VD and CT (R = .250;P ≤ .006), while correlation with age was negative in the SCP and CC (R = -.283;P

To determine corneal topographic, anatomic, and biomechanical properties in patients newly diagnosed with severe obstructive sleep apnea-hypopnea syndrome (OSAHS).This is a cross-sectional study including 25 patients recently diagnosed with severe OSAHS (apnea-hypopnea index above 30) and a paired control group of 25 healthy subjects. All patients underwent a complete eye examination with an elevation topography Pentacam Scheimpflug study and a study with Reichert Ocular Response Analyzer, collecting several topographic, anatomic, and biomechanical variables.Fifty eyes of 25 patients (23 of them were men) diagnosed with OSAHS by somnography and the same number of healthy subjects (23 of them were men) were included, with an average age of 64 ± 11 years (range 45-78 years) for cases and an average age of 64 ± 11 years (range 45-81 years) for the controls. No differences were found in keratometry, cylinder, refractive indexes, Bad-D, or pachymetry. The mean corneal volume for cases was 58.64 ± 3.05 mm and for the controls 60.48 ± 3.33 mm (P = 0.005). The mean minimum radius for cases was 7.49 ± 0.31 and for the controls 7.36 ± 0.30 (P = 0.035). The mean elevation in apex for cases was 8.46 ± 5.18 and for the controls 2.38 ± 2.36 (P ≤ 0.001). Two eyes with a topographic diagnosis of keratoconus (KC) and another 6 with subclinical KC were detected using the Pentacam in the OSAHS group.Many of the corneal topographic and biomechanical variables in patients with severe OSAHS present different values from the general population with a trend toward KC values, such as keratoconus index or paired keratoconus index. Compared with the control group, significant differences were found in corneal volume, corneal elevation, and minimum radius.

IMPORTANCE Rare transforming growth factor beta-induced (TGFBI) gene variants are involved in autosomal dominant corneal dystrophies (CDs) with heterogeneous clinical features. BACKGROUND The purpose of this study was to analyse TGFBI gene variants and genotype-phenotype correlations in a cohort affected by atypical stromal CD. DESIGN Retrospective cohort study (from May 2014 to September 2017). PARTICIPANTS Thirty-five individuals from 10 unrelated South European families presenting atypical lattice CD (LCD) were included. METHODS Corneal phenotypes were assessed by slit-lamp examination and optical coherence tomography (OCT). Contrast sensitivity was measured under mesopic conditions. Genomic DNA was obtained from blood samples, and all 17 TGFBI exons were screened for variants by Sanger sequencing. MAIN OUTCOME MEASURES p.(L558P) variant of TGFBI gene. RESULTS The p.(L558P) variant was identified in 22 members of the 10 families diagnosed with atypical LCD, characterized by late-onset and absence of recurrent erosion syndrome. OCT revealed punctiform deposits in the deep-mid stroma and normal anterior stroma. This variant was demonstrated to be transmitted with the disease according to autosomal dominant inheritance in most families. CONCLUSIONS AND RELEVANCE To the best of our knowledge, we describe a detailed clinical characterization of the largest CD cohort carrying the TGFBI p.(L558P) variant. We propose that the atypical phenotype of this recently reported alteration can be classified as a form of LCD type IV. The results show that OCT and anterior-posterior analysis of the stromal location of the opacities, along with a genetic analysis of TGFBI, are required to ensure accurate diagnosis and management of CDs.

Purpose: To assess the reproducibility of swept-source optical coherence tomography angiography (SS-OCTA) for macular and optic nerve head (ONH) vessel density (VD). Methods: Cross-sectional study using the Triton OCTA (Topcon, Tokyo, Japan), for VD (%) measurements in 40 eyes of 40 healthy subjects on two 6 × 6 mm scans of the macula and ONH across five subfields (central, superior, inferior, temporal, and nasal) at different segmentation levels: superficial capillary plexus (SCP), deep capillary plexus (DCP), outer retina, and choriocapillaris. Reproducibility values were summarized as intraclass correlation coefficients (ICCs) and coefficients of variations (CV). Results: ICCs for the macular VD measurements in the central zone were 0.874, 0.770, 0.575, 0.718 at the levels SCP, DCP, outer retina, and choriocapillaris, respectively, while worse ICCs were obtained for the parafoveal subfields (ICC ⩽ 0.589); CVs were 2.8%–6.7%. The reproducibility of the ONH superficial VD was ICC = 0.941 for the papillary region and was ICC = 0.499–0.853 for the peripapillary zone; CVs ranged from 4.8% to 17%. Peripapillary VD showed an ICC = 0.533–0.770 in the DCP layer, and 0.572–0.828 in the choriocapillaris. Lowest VD were obtained for the macular SCP and DCP (23% and 22%, respectively), in the foveal zone, while greatest VD were recorded in the nasal and temporal peripapillary subfields at the level of the choriocapillaris (both 68%). Conclusions: The new SS-OCTA software served to quantify macular and ONH VD with a reproducibility that was good in the central zones (foveal and papillary, respectively) and moderate in the peripheral zones (parafoveal and peripapillary).

SARS-CoV-2 is a highly transmissible virus that spreads mainly via person-to-person contact through respiratory droplets, or through contact with contaminated objects or surfaces from an infected person. At present we are passing through a phase of slow and painful understanding of the origin, epidemiological profile, clinical spectrum, and risk profile of the virus. To the best of our knowledge there is only limited and contradictory evidence concerning SARS-CoV-2 transmission through other routes. Importantly, the eye may constitute not only a potential site of virus replication but also an alternative transmission route of the virus from the ocular surface to the respiratory and gastrointestinal tract. It is therefore imperative to gain a better insight into the potential ophthalmological transmission route of the virus and establish directions on best practice and future models of care for ophthalmological patients. This review article critically evaluates available evidence on the ophthalmological mode of viral transmission and the value of earlier identification of the virus on the eye. More evidence is urgently needed to better evaluate the need for protective measures and reliable ocular diagnostic tests to diminish further pandemic spread.

The seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was examined among 105 healthcare workers (HCWs) exposed to four patients who were laboratory confirmed with coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2 infection. These HCWs were immediately under quarantine for 14 days as soon as they were identified as close contacts. The nasopharyngeal swab samples were collected on the first and 14th day of the quarantine, while the serum samples were obtained on the 14th day of the quarantine. With the assay of enzyme immunoassay (EIA) and microneutralization assay, 17.14% (18/105) of HCWs were seropositive, while their swab samples were found to be SARS-CoV-2 RNA negative. Risk analysis revealed that wearing face mask could reduce the infection risk (odds ratio [OR], 0.127, 95% confidence interval [CI] 0.017, 0.968), while when exposed to COVID-19 patients, doctors might have higher risk of seroconversion (OR, 346.837, 95% CI 8.924, 13479.434), compared with HCWs exposed to colleagues as well as nurses and general service assistants who exposed to patients. Our study revealed that the serological testing is useful for the identification of asymptomatic or subclinical infection of SARS-CoV-2 among close contacts with COVID-19 patients.

Purpose The purpose of this study was to evaluate the frequency and clinical presentation of conjunctivitis in hospitalized patients with COVID-19. Methods A cross-sectional study was conducted at the Hospital Clinico San Carlos of Madrid, Spain. A total of 301 subjects from the COVID admission unit with laboratory-confirmed SARS-CoV-2 infection were included. The presence and clinical characteristics of conjunctivitis were evaluated. Laboratory, radiological, and clinical results in patients with and without conjunctivitis stratified by sex were analyzed. Results Of the 301 subjects included, 180 patients (59.8%) were male and the median age was 72 years (IQ 59–82). Overall, 35 patients (11.6%) were diagnosed with acute conjunctivitis. We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. The natural history of the disease seems to be a rapid self-limited conjunctivitis that improves without treatment and does not affect visual acuity nor associate short-term complications. Conclusions Approximately, 1 out of 10 hospitalized non-critical COVID-19 patients presents conjunctivitis during the disease. Compared with other viral conjunctivitis, we found distinctive clinical findings that could guide defining and differentiating conjunctivitis in COVID-19 patients. Trial registration number 20/336_E_COVID

The purpose was to review and document the methods used to calculate the power of the intraocular lens (IOL) to be implanted in cataract surgery in the specific scenario of eyes with keratoconus (KC). This review was conducted of all scientific articles published in English that focused on the parameters and formulas used to calculate the power of the IOL to be implanted in eyes with KC undergoing cataract surgery. There are few publications that show in detail how IOL power is calculated in those particular cases. If the keratometric value is used based on the standard refractive index (1.3375), this results in a postoperative refractive error with a tendency to hyperopia. The SRK/T formula is the formula yielding the best outcomes. The greater the severity of KC, the greater the deviation of the postoperative refractive status deviation from the target outcome.

Introduction Polychromatic corneal dystrophy is an unusual pre-Descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. Clinical cases Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicolored brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-Descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. Conclusions Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterized. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

Resumen Introduccion La distrofia corneal policromatica es una rara distrofia predescemetica, con pocos casos publicados. Presentamos los hallazgos encontrados mediante lampara de hendidura, biomicroscopia especular y confocal en una serie de 4 casos de esta entidad. Casos clinicos Se trata de 4 mujeres de entre 36 y 72 anos, diagnosticadas de distrofia corneal policromatica en revisiones rutinarias. Ninguna referia sintomas visuales ni antecedentes oculares de interes. La biomicroscopia anterior objetivo multiples y pequenas opacidades brillantes multicolores en la zona posterior del estroma corneal, con respeto epitelial y estromal anterior. Las opacidades eran bilaterales y distribuidas por toda la cornea. Se exploro a familiares directos, los cuales no presentaban opacidades. En la biomicroscopia especular se observaba un endotelio normal con particulas hiperreflectivas predescemeticas. En la microscopia confocal no se objetivaron alteraciones en epitelio, capa de Bowman y plexo nervioso subbasal. En 2 casos se apreciaban en el estroma anterior queratocitos hiperreflectivos y pequenas particulas hiperreflectivas entre ellos. En cuanto al estroma medio, aparecian queratocitos hiperreflectivos en los 4 casos, particulas hiperreflectivas de pequeno tamano en 2 y en los otros 2 existian queratocitos anormales con procesos prominentes. El estroma posterior en los 4 casos mostro gran cantidad de queratocitos hiperreflectivos y de particulas hiperreflectivas de distintos tamanos. Tales particulas impedian la exploracion del endotelio. Conclusiones La distrofia corneal policromatica presenta signos tipicos en la exploracion, que permiten su diagnostico y caracterizacion. Aunque la imagen biomicroscopica parece evidenciar alteraciones solo en el estroma posterior, la microscopia confocal demuestra que la distrofia afecta a todo el estroma corneal.

Objective This study was designed to assess changes in corneal topography and biomechanics after intraocular pressure (IOP) monitoring using the Triggerfish contact lens sensor (CLS). Methods For this prospective study, 30 eyes of 30 subjects: 14 healthy subjects (G1) and 6 glaucoma patients (G2), were recruited for 24 hours of continuous IOP monitoring using the CLS. The following measurements were taken before CLS fitting and after lens removal: maximum keratometry (Kmax), mean keratometry (MK), and corneal astigmatism (Cyl) measured through Pentacam corneal topography, and the corneal biomechanical variables corneal hysteresis (CH) and corneal resistance factor (CRF) measured with the Ocular Response Analyzer (ORA). Results Pentacam data revealed significant changes after CLS removal in Kmax (+3.14 ± 2.46 D, p = 0.002), MK (+0.52 ± 0.63 D, p = 0.02), and Cyl (+0.48 ± 0.53 D, p = 0.019) in G1; and Kmax (+1.38 ± 1.43 D, p = 0.002) in G2. The changes observed were more pronounced in G1 than in G2 but differences were not significant. The ORA results indicated higher CH (11.35 ± 2.42 vs 8.17 ± 2.09) and CRF (10.3 ± 2.03 vs 9.1 ± 1.81) before lens fitting in G1 than G2, while no significant changes were produced after CLS removal in either group. Conclusions The use of CLS for IOP monitoring over 24 hours caused topographic changes in both healthy subjects and glaucoma patients. No changes were produced in corneal biomechanics.

Summary Introduction To determine outcomes of conjunctival autograft attached with fibrin glue (FG) for primary pterygium , and compare these outcomes in expert versus closely supervised trainee ophthalmologists. Methods This was a retrospective, comparative, non-randomized, interventional study. Patients were recruited among those with primary nasal pterygium undergoing FG conjunctival autograft. Surgery was performed by expert (136 eyes) or closely supervised trainee (128 eyes) ophthalmologists. Mean follow-up was 7.82 ± 8.23 months. Main outcome measures were recurrence rate, reoperation rate and complications. Results The study sample comprised 264 eyes of 225 patients. Participants were of mean age 47.09 ± 12.89 years; 46.7% were male, 28.4% Caucasian and 70.5% Hispanic. Recurrence was recorded in 6.4%: 5.9% in the expert group and 7% in the trainee group (P = 0.704) and reoperation in 1.9%: 0.7% and 3.1% (P = 0.202), respectively. Both groups showed similar rates of complications such as transient graft edema, graft dehiscence, hematoma or ocular hypertension . Reoperation was slightly more frequent in patients younger than 40 years (P = 0.064). Conclusions Good outcomes were observed for FG conjunctival autografting in primary pterygium surgery, with no differences recorded between supervised trainee and expert surgeons. Our findings suggest the need to supervise pterygium surgeries during training.

PURPOSE To report 2 cases of cornea verticillata (CV) after vandetanib treatment for medullary thyroid carcinoma (MTC). METHODS In this retrospective interventional, case-report study, 2 patients who under vandetanib treatment for MTC were referred to our ophthalmology department because of vision complaints. Both subjects underwent a complete ophthalmologic examination, including confocal microscopy (CM) using the Heidelberg Retina Tomograph and Rostock Cornea Module. RESULTS A 70-year-old man and a 43-year-old woman, both with a history of MTC under treatment with vandetanib for 5 months and 30 months, respectively, presented with blurred vision. In both patients, a mild CV pattern was observed although deposits were more evident in the male patient. CM images showed hyperreflective deposits in the corneal epithelium and subepithelial nerve plexus. Bright microdots were also seen throughout the stroma, along with a few hyperreflective keratocytes in the anterior stroma. CONCLUSIONS In both patients, vandetanib seemed to be the cause of CV. The CM images supported the idea of drug-lipid complex deposits in vandetanib-induced CV.

Purpose To examine the relationship between ocular surface disease (OSD) and topical antiglaucoma therapy. Methods A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication were recruited over 10 months. Controls were 51 eyes of 51 healthy age- and sex-matched volunteers. In each patient, we recorded the intraocular pressure-lowering eyedrops used, the number of medications used, and daily and cumulative preservative concentrations (PC). Main outcome measures were fluorescein corneal staining score (Oxford scale), lower tear meniscus height (LTMH) (spectral-domain optical coherence tomography), noninvasive tear film breakup time (NI-TBUT) (Oculus Keratograph 5M), and OSD symptom questionnaire index (OSDI). Results Compared to controls, significantly higher OSDI (median [interquartile range] 10.24 [4.54-18.94] vs 2.5 [0-12.5]; p0.05). A higher daily PC was associated with a lower LTMH (R −0.142; p = 0.043). In the medication group, multivariate analysis identified correlations between benzalkonium chloride (BAK) (odds ratio [OR] 1.56) and BAK plus polyquaternium-containing drops (OR 5.09) or higher OSDI (OR 1.06) and abnormal corneal staining test results and between older age (mean ratio [MR] 1.05), longer treatment duration (MR 1.02), or corneal staining presence (MR 1.22) and a higher OSDI score. Conclusions Ocular surface disease was more prevalent in the medication group. The main factors impacting OSD were drops with preservatives, longer treatment duration, and older age.

Purpose: To determine variations in cytokine levels of glaucoma patients treated either with preservative-free latanoprost or preserved latanoprost, relative to healthy individuals. Methods: Tear samples were collected from 39 healthy subjects, 20 glaucoma patients treated with preserved latanoprost, and 20 patients treated with preservative-free latanoprost. A set of 27 inflammatory cytokines was analyzed in each group, including interleukin (IL)-1β, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor (FGF) basic, granulocyte colony stimulating factor (G-CSF), granulocyte monocyte colony stimulating factor (GM-CSF), interferon (IFN)-γ, interferon gamma-induced protein (IP)-10, monocyte chemo attractant protein (MCP)-1MCAF, macrophage inflammatory protein (MIP)-1α, MIP-1β, platelet-derived growth factor (PDGF)-BB, regulated on activation, normal T cell expressed and secreted (RANTES), tumor necrosis factor (TNF)-α and vascular endothelial growth factor (VEGF). Cytokine concentrations were obtained by the Bio-Plex Human Cytokine Immunoassay. Non-invasive tear breakup time (NI-TBUT), tear meniscus height, corneal fluorescein staining, conjunctival hyperemia and ocular surface disease index (OSDI) were assessed in patients treated with preservative-free and preserved latanoprost. Results: The levels of IL-2, IL-5, IL-10, IL-12 (p70), IL-13, IL-15, IL-17, FGF basic, PDGF-BB, and TNF-α were significantly higher in patients receiving preserved latanoprost, compared to normal controls (p < 0.05). The expression of all the cytokines studied remained statistically invariable in patients receiving preservative-free latanoprost, compared to healthy subjects (p > 0.05). Ocular surface parameters were not significantly different in both glaucoma groups, and no correlation between these clinical parameters and cytokine levels was observed. Conclusions: Treatment with preserved latanoprost has a direct impact on tear cytokine levels, whereas this effect is not observed upon preservative-free latanoprost instillation.

Purpose To assess intraobserver repeatability and interobserver and intersession reproducibility of lower tear meniscus height (LTMH) measurements obtained using a new anterior segment swept-source optical coherence tomography (SS-OCT) device. Agreement with Fourier-domain (FD) OCT (Spectralis) was also examined. Methods In an observational cross-sectional study, one eye of 29 healthy subjects was randomly imaged with both devices at our center. Two examiners then randomly measured the LTMH using the software's calipers. To assess intraobserver repeatability and interobserver and intersession reproducibility, within-subject standard deviation (Sw), test-retest repeatability, coefficients of variation (CoV), and intraclass correlation coefficients (ICCs) were calculated. Agreement between both devices was also determined in Bland-Altman plots. Results Mean LTMHs for SS-OCT and FD-OCT were 276.6 ± 87.6 and 280.3 ± 80 μm, respectively. Using the SS-OCT device, intraobserver CoV, interobserver CoV, and intersession CoV were found to be ≥16.9%, ≤7.2%, and ≤11.5%, respectively. ICCs for these parameters were ≤88%, ≥97%, and ≥94%, respectively. Bland-Altman analysis indicated poor agreement between SS-OCT and FD-OCT, and the correlation was low (CoV 34.5%, ICC 0.36). Conclusions SS-OCT LTMH measurements showed excellent interobserver and intersession repeatability along with good intraobserver reproducibility. Agreement between the devices was poor.

Purpose: To estimate the incidence rate (IR) and identify risk factors associated to inflammatory relapse after immunosuppressive drug (ISD) discontinuation in noninfectious uveitis patients. Methods: Multicenter longitudinal retrospective study, including patients from four uveitis clinics followed-up until December 2018. Hazard ratios for different variables were estimated using multivariable Cox models. Results: 32 patients (34 episodes of ISD discontinuation) were analyzed (median and maximum follow-up time: 2.4 and 19.2 years, respectively). Fourteen patients presented at least one relapse: anterior (8 patients), intermediate (5) and posterior (8). IR (95% confidence interval) of the first relapse was 14.3 (8.6–23.8) episodes per 100 patient-years (median survival time: 4.8 years). Early use of ISDs, panuveitis, and higher oral corticosteroid dosage at discontinuation were associated with higher hazards of relapse in multivariable analysis. Conclusions: Relapse is a frequent and early event after ISD discontinuation. Identifying relapse risk factors could support the physician’s decision regarding ISD discontinuation. Instituto de Salud Carlos III (ISCIII), Ministerio de Sanidad, Consumo y Bienestar Social (Contrato de investigación Miguel Servet: CPII17 / 00014 a LRR). 3.728 JCR (2021) Q2, 23/62 Ophthalmology 1,232 SJR (2021) Q1, 21/128 Ophthalmology No data IDR 2021 UEM

Summary Purpose To describe ocular biometric parameters and the prevalence of corneal astigmatism as well as age and gender correlations in a population of cataract surgery candidates and to estimate the number of eyes that would be candidates for a toric intraocular lens (IOL). Methods In consecutive patients requiring cataract surgery over a one-year period (June 2016 to June 2017), the following optical biometry measurements were performed on an IOLMaster 700 or Lenstar 900: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (K), flat keratometry (K1), steep keratometry (K2), corneal astigmatism (Cyl) and white-to-white diameter (WTW). Descriptive statistics for the demographic and biometric data were analyzed. Results The study sample included 6111 eyes of 3332 patients (59.3% women), with a mean age of 74.78 ± 9.7 years. The means of the compiled data are as follows: AL 23.58 ± 1.55 mm, ACD 3.08 ± 0.41 mm, LT 4.55 ± 0.52 mm, K 44.15 ± 1.54 diopters (D), K1 43.64 ± 1.57 D, K2 44.69 ± 1.61 D, Cyl 1.0 ± 0.81. D and WTW 11.88 ± 0.46 mm. The male patients had significantly larger eyes (higher AL, ACD and WTW) and flatter corneas (lower flat and steep K). Older patients had significantly lower AL, ACD and WTW, while their LT values were higher. Corneas became significantly steeper with age. 60.5% of eyes had less than 1 D of corneal astigmatism, while 3.1% had ≥ 3.0 D. Conclusions Less than 1 D of corneal astigmatism was present in the majority of cataract surgery candidates. 3.1% of eyes were candidates for a toric IOL. This study provides useful information on inventory requirements for planning hospital resources.

PURPOSE To examine ciliary muscle (CM) dimensions in vivo by swept-source optical coherence tomography (SS-OCT) in a large healthy population. To assess the reproducibility of CM measurements and correlations with different parameters. METHODS In this cross-sectional study, the following CM measurements were made in 495 eyes of 495 subjects in the temporal and nasal quadrants: length (CML), area (CMA) and thickness at distances of 1000 μm (CMT1), 2000 μm (CMT2) and 3000 μm (CMT3) from the scleral spur using the SS-OCT DRI-Triton® (Topcon, Tokyo, Japan). These dimensions were then assessed for correlations with the factors age, gender, refractive error, anterior chamber angle (ACA) and intraocular pressure (IOP). The reproducibility of CM measurements was determined in 85 of the participants. RESULTS Mean age was 41.4 ± 17.5 years (range 5-83). The following means were recorded as follows: CML = 4.57 ± 0.73 mm (range 2.16-6.97), CMA = 1.35 ± 0.31 mm2 (2.04-5.45), CMT1 = 558 ± 98 μm (299-891), CMT2 = 366 ± 100 μm (89-629) and CMT3 = 210 ± 75 μm (36-655). Negative correlation was detected between CML/CMA and age (R = -0.516/R = -0.404; p

To compare corneal densitometry and topography variables in patients with primary congenital glaucoma (PCG) and healthy subjects.Cross sectional study, consecutive recruitment with gender- and age-matched control group. Forty eyes of 40 patients in each group were studied with Pentacam corneal topography. The variables compared between the two groups were: intraocular pressure (IOP), visual acuity (VA) and Pentacam (Oculus, Wetzlar, Germany) corneal topography measurements: mean and maximum keratometry (Km, Kmax), cylinder (Cyl), anterior elevation apex (AEA), central anterior elevation (CAE), maximum anterior elevation (MAE), posterior elevation apex (PEA), central posterior elevation (CPE), maximum posterior elevation (MPE), pachymetry and anterior, mid-stromal and posterior corneal densitometry in the 0-2mm, 2-6mm, 6-10mm zones.Significant differences between patients and healthy controls were detected in the topographic variables MAE (P=0.002) and MPE (P0.001), and in all the densitometry variables (anterior, mid-stromal, posterior for the 0-2mm, 2-6mm and 6-10mm zones) (P0.001 each). In the PCG group, negative correlation was observed between VA and total densitometry (r=-0.49; P=0.004).Patients with PCG and healthy subjects display differences in corneal densitometry and topographic measurements. PCG patients show greater corneal density with an inverse relationship between visual acuity and higher elevation (anterior and posterior values).

Objective: To assess incidence and risk factors of cataract extraction in patients with primary congenital glaucoma, surgical outcome, and complications. Material and method: Retrospective cohort study, in which 108 patients with primary congenital glaucoma were included. Data collected were need for cataract extraction and at what age, intraocular pressure at diagnosis of primary congenital glaucoma, required antiglaucomatous surgeries, possible mutation in the CYP1B1 gene, and final visual acuity. Among the patients who required cataract extraction were visual acuity, intraocular pressure, and complications, evaluated preoperatively and postoperatively. The data were analysed with STATA. Results: A total of 198 eyes of 108 patients were included, with a median follow-up of 8 years (range: 5–53). In all, 32 eyes (16.2%) of 24 patients (22%) required cataract extraction. The median age for cataract extraction was 12.94 years (interquartile range: 2.42–22). The main identified risk factors associated with cataract extraction were antiglaucomatous surgeries (hazard ratio 1.48, p Conclusions: There is a high incidence of cataract surgery in patients with primary congenital glaucoma, but generally outside of pediatric age. A greater risk of cataract extraction was identified in those patients with a greater number of antiglaucomatous surgeries, especially after valvular implantation. Despite the high rate of complications related to cataract extraction in primary congenital glaucoma, good visual improvement was observed after surgery.

Objective: To evaluate the potential utility of perfusion density measurements to discriminate patients with arterial hypertension by cardiovascular risk category. Methods: In this cross-sectional study, one eye per subject was evaluated (N = 73). The study cohort was divided into three groups according to the clinical criteria established by the European Guidelines for Arterial Hypertension: 26 controls, 24 patients with low cardiovascular risk, and 23 patients with very high cardiovascular risk. All patients were examined using RS-3000 Advance optical coherence tomography angiography to analyze macular and peripapillary perfusion density. Results: There were no differences among the three risk groups by sex or age. Decreased macular perfusion density was found at the level of the superficial and deep plexuses (p ⩽ 0.047). No differences were observed in peripapillary perfusion density (p = 0.18). Conclusion: Optical coherence tomography angiography can detect changes in macular perfusion density in patients with hypertension and high cardiovascular risk and might represent a supportive imaging method in the evaluation of the cardiovascular risk in hypertensive patients.

Cenozoic shortening history and linked mountain building of the Sub-Andean Zone in Peru is genetically related to the subduction of the Nazca Plate. This convergent event governed the construction of Central Andes, the development of sedimentary basins, and their compartmentalization in smaller sub-basins. The structural styles observed varied from salt tectonics-related structures to thin- and thick-skinned structures. These differences in structural styles within the Sub-Andean Zone are controlled by the Pre-Andean history. Despite the common Paleozoic history of basin evolution, variation in late Paleozoic-early Mesozoic evolution has exerted a strong control on the structural styles along strike. Middle-Late Triassic extension affected the northern Sub-Andean Zone bounding a suite of grabens and half-grabens, and late Jurassic-Early Cretaceous postrift thermal subsidence controlled the deposition of Mesozoic evaporitic sequences. These sequences acted as effective detachments during Andean deformation developing thin-skinned structures, while pre-existing normal faults were reactivated producing thick-skinned structures. The southern Sub-Andean Zone, practically unaffected by the Middle-Late Triassic extension, preserves a continuous and thick Paleozoic sequence, deformed by thin-skinned structures detaching at the top of the Ordovician-Silurian sequence. Nevertheless, fault reactivation of pre-existing lowermost Paleozoic-Proterozoic extensional faults also produced significant uplift of the Sub-Andean fold-thrust belt of Peru.

Dry eye is commonly treated with artificial tears; however, developing artificial tears similar to natural tears is difficult due to the complex nature of tears. We characterized and evaluated a novel artificial tear formulation with components similar to the lipid and aqueous constituents of natural tears. Nano-liposomes, composed in part of phosphatidylcholine, were dispersed in an aqueous solution of bioadhesive sodium hyaluronate. Liposome size, zeta potential, and physicochemical properties of the fresh and stored (4°C) liposomal formulation were analyzed. In vitro tolerance was tested using human corneal and conjunctival cell lines by exposures of 15 min to 4 h. The tolerance of the liposomal formulation was evaluated in animals (rabbits). The average liposome size was 186.3 +/- 7.0 nm, and the zeta potential was negative. The osmolarity of the formulation was 198.6 +/- 1.7 mOsm, with a surface tension of 36.5 +/- 0.4 mN/m and viscosity of 3.05 +/- 0.02 mPa·s. Viability values in the human corneal and conjunctival cell lines were always >80%, even after liposomal formulation storage for 8 weeks. Discomfort and clinical signs after instillation in rabbit eyes were absent. The new formulation, based on phosphatidylcholine-liposomes dispersed in sodium hyaluronate has suitable components and characteristics, including high in vitro cell viability and good in vivo tolerance, to serve as a tear substitute.