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PURPOSE To describe and evaluate demographic, clinical features, prognostic factors, and rate of success of surgery and visual outcomes in patients with late presentation of retinal detachment. METHODS A retrospective, comparative, observational case series of patients with late presentation retinal detachment, defined as retinal detachment with the loss of central vision for 4 weeks or more, over a period of 12 months. RESULTS The mean of onset of central visual loss was 12.7 weeks (SD, 21.3). Proliferative vitreoretinopathy at the first operation was identified in 69% of eyes. The overall primary success rate was 69.2%, significantly less than that was found in outcomes for nonselected retinal detachment (primary success rate, 86%; P = 0.006). The initial best-corrected visual acuity was 20/500, and the final was 20/160 (P = 0.0027). There were no identifiable statistically significant socioeconomic factors related to late presentation. CONCLUSION A high rate of established proliferative vitreoretinopathy on presentation was identified, and although cases can be treated with good anatomical results, visual outcomes are often less favorable. Primary surgical success is lower, and more reoperations are required compared with standard retinal detachments.

Due to the guarded prognosis of acute retinal necrosis (ARN), it is relevant to develop a strategy to early categorize those patients in a higher risk of worse outcomes. The purpose of this study is to describe clinical features and predictive factors for retinal detachment (RD) in patients with ARN. Retrospective observational case series of 34 adult patients (38 eyes) with ARN examined between January 2005 and July 2015 in the National Eye Institute (Bethesda, USA), the Department of Ophthalmology, University of Chile (Santiago, Chile), and APEC (CDMX, Mexico). A total of 16 males and 18 females with a mean age at presentation of 44.5 ± 16.8 years were included. Twenty-seven patients (79.4%) received intravenous acyclovir as first-line treatment, and 7 patients received either oral antiviral (4 patients) or oral plus intravitreal antiviral (3 patients). All subjects were treated with prednisone, with a mean initial dose of 57.7 ± 16.3 mg per day. Seventeen patients (50.0%) developed retinal detachment. An association of retinal detachment with age at onset was observed (p = 0.04), with patients younger than 50 years presenting a higher risk (OR = 14.86, p = 0.0009). Additionally, patients in this higher risk group had more inflammation in both anterior chamber and vitreous (p = 0.04 and 0.03, respectively). No other predictive factor for retinal detachment was found in the present study. RD represents an important complication in patients with ARN. Younger patients may be at higher risk of this complication, possibly secondary to the presence of a higher level of inflammation.

Vision loss after detachment of the neurosensory retina is a complex process which is not fully understood. Clinical factors have been identified which contribute to loss of macular function after retinal detachment and laboratory studies have played an important role in understanding the cellular and subcellular pathological processes which underlie the loss of visual function. As clinical imaging has advanced, multiple studies have focused on identifying and correlating clinicopathological features with visual outcomes in patients with rhegmatogenous retinal detachment. Optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography and adaptive optics studies have contributed to the understanding of the anatomical changes in relation to clinical outcomes. A clear understanding of the macular pathology of retinal detachment is fundamental to develop strategies to improve outcomes in patients with rhegmatogenous retinal detachment and analogous retinal diseases where macular neurosensory retinal detachment is part of the pathology. This review assesses the evidence from experimental and pathological studies together with clinical imaging analyses (optical coherence tomography, fundus autofluorescence, optical coherence tomography angiography and adaptive optics) and the contribution of these studies to our understanding of visual outcomes.

Purpose To investigate the potential of utilizing the expression of genes for glucocorticoid receptor (GR) and mitogen-activated protein kinase phosphatase-1 (MKP-1) as biomarkers of corticosteroid (CS) refractoriness and disease activity in patients with Vogt-Koyanagi-Harada (VKH) disease. Design Prospective cohort study. Methods Twenty VKH patients receiving their first cycle of CS treatment in the absence of additional systemic immunosuppressive therapy and a control group of fifteen healthy volunteers were recruited from the University of Chile (Santiago, Chile) and US National Institutes of Health (Bethesda, United States). Intraocular inflammation was clinically quantified at enrolment and all follow-up visits. CS refractoriness was defined as an ocular reactivation of VKH upon CS withdrawal at a daily oral prednisone dose of 10 mg or more. Quantitative Reverse transcription polymerase chain reaction (qRT-PCR) was performed to measure the mRNA levels of the alpha (α) and beta (β) isoforms of GR and MKP-1 in peripheral blood mononuclear cells (PBMC) after in vitro stimulation with either anti-CD3/anti-CD28 antibodies, lipopolysaccharide (LPS), or phytohemagglutinin (PHA), in the presence or absence of dexamethasone (Dex). Results After 6 hours of stimulation in the presence of Dex, PBMC from CS-refractory VKH patients had an impaired elevation in GRα expression (P = .03). Furthermore, inactive patients showed a significant Dex-induced upregulation of MKP-1 (P = .005). Conclusions In this pilot study, the expression of GR isoforms and MKP-1 corresponded with patients' clinical response to systemic CS treatment and disease activity, respectively. Hence, these candidate biomarkers have potential clinical utility in the early identification of CS refractoriness and subclinical inflammation in patients with VKH disease.

Objective: To assess the patterns of patient generated aerosol in the context of ophthalmic surgery and ophthalmic examinations. To inform medical teams regarding potential hazards and suggest mitigating measures. Methods: Qualitatively, real-time time videography assessed exhalation patterns from simulated patients under different clinical scenarios using propylene glycol from an e-cigarette. Quantitatively, high-speed Schlieren imaging was performed to enable high resolution recordings analysable by MATLAB technical computing software. Results: Without a face mask, the standard prior to COVID 19, vapour was observed exiting through the opening in the drape over the surgical field. The amount of vapour increased when a surgical mask was worn. With a taped face mask, the amount of vapour decreased and with inclusion of a continuous suction device, the least amount of vapour was seen. These results were equivocal when the patient was supine or sitting upright. High-speed Schlieren imaging corroborated these findings and in addition showed substantial increase in airflow egress during coughing and with ill-fitting face masks. Conclusion: Advising patients to wear a surgical mask at the time of ophthalmic interventions potentially contaminants the ocular field with patient generated aerosol risking endophthalmitis. Surgeon safety can be maintained with personal protective equipment to mitigate the increased egress of vapour from the surgical drape and taping, with or without suction is advisable, whilst meticulous hygiene around lenses is required at the time of slit lamp examination.

The COVID-19 pandemic has had an unprecedented impact on the National Health Service in United Kingdom. The UK Ocular Oncology Services evaluated the impact on the adult eye cancer care in the UK. All four adult Ocular Oncology centres participated in a multicentre retrospective review comparing uveal melanoma referral patterns and treatments in a 4-month period during the national lockdown and first wave of the COVID-19 pandemic in 2020 with corresponding periods in previous 2 years. During the national lockdown, referral numbers and confirmed uveal melanoma cases reduced considerably, equalling to ~120 fewer diagnosed uveal melanoma cases compared to previous 2 years. Contrary to the recent trend, increased caseloads of enucleation and stereotactic radiosurgery (p > 0.05), in comparison to fewer proton beam therapy (p

Aflibercept is a fully human recombinant fusion protein that includes the second domain of human VEGF receptor 1 and the third domain of human VEGF receptor 2. Despite the important role played by VEGF in maintaining the physiological condition of the retina under normal conditions, dysregulation of VEGF can result in pathological alterations including hyperpermeability of the retinal capillaries and migration and proliferation of retinal endothelial cells. Over the years, a number of studies have evaluated the use of intravitreal aflibercept in different retinal diseases. In this review, we aim to summarize the scientific evidence and recommendations for use of intravitreal aflibercept in neovascular age-related macular degeneration, diabetic macular oedema, macular oedema associated with retinal vein occlusion, and myopic choroidal neovascularization.

Purpose: To report a case of vascularized idiopathic epiretinal membrane including the multimodal imaging. Methods: Findings on clinical examination, color fundus photography, spectral-domain optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography. Results: Sixty-three-year-old woman with a previous rhegmatogenous retinal detachment (RRD) who presented with an asymptomatic idiopathic neovascular complex below an epiretinal membrane. It was assessed with fluorescein angiography, OCT and OCT-A. The vascularized ERM was already present previously to the retinal detachment. Conclusion: Our case report describes an example of idiopathic epiretinal membrane complicated by neovascularization; we hypothesized hypertension could be one of the factors in this case, as it may lead to decreased retinal perfusion and upregulation in vascular endothelial growth factor (VEGF). Multimodal imaging can help in detecting neovascularized ERM.

Varied options are available for the implantation of secondary intraocular lens implants in the absence of zonular or capsular support. Loss of the capsule can occur in the context of complicated cataract surgery, trauma or inherited conditions such as Marfan syndrome or pseudoexfoliation. Approaches to overcome this include optical measures such as the use of spectacles or contact lenses, and surgical therapy incorporating the use of anterior chamber, iris-fixated or scleral-fixated lenses. Surgical techniques to implant scleral-fixated lenses have undergone various modifications, since the first publication of sutured intrascleral fixation described in the 1980s. However, despite the advances in surgical techniques, studies are limited either by their retrospective nature, small sample size and most importantly small duration of follow-up. This comprehensive review aims to amalgamate the evolution of various surgical techniques with regards to intrascleral lens fixation and suggests areas for future development.摘要: 经巩膜缝线固定的眼内人工晶状体植入术——手术技术的演变与未来发展摘要在缺乏晶状体悬韧带或囊膜支撑的情况下, 二期人工晶状体植入有多种选择。在复杂性白内障手术、外伤或遗传性疾病 (如马凡氏综合征或假性脱落) 的白内障手术中, 可能会出现晶状体囊膜缺失的情况。而光学治疗措施 (佩戴框架眼镜或隐形眼镜) 以及手术方法 (结合使用前房、虹膜固定或巩膜固定的人工晶状体) 可以解决问题。自20世纪80年代首次发表关于巩膜内固定术的文章以来, 植入经巩膜缝线固定人工晶体的外科技术经历了各种各样的改进。然而, 尽管外科手术技术有了进步, 但由于研究为回顾性、样本量小和最重要的随访时间短, 研究结果不尽人意。本综述旨在深度探讨经巩膜缝线固定人工晶状体植入术的进展, 并对今后的发展方向提出建议。#32463;#24041;#33180;#32541;#32447;#22266;#23450;#30340;#30524;#20869;#20154;#24037;#26230;#29366;#20307;#26893;#20837;#26415;#8212;#8212;#25163;#26415;#25216;#26415;#30340;#28436;#21464;#19982;#26410;#26469;#21457;#23637;#25688;#35201;#22312;#32570;#20047;#26230;#29366;#20307;#24748;#38887;#24102;#25110;#22218;#33180;#25903;#25745;#30340;#24773;#20917;#19979;#65292;#20108;#26399;#20154;#24037;#26230;#29366;#20307;#26893;#20837;#26377;#22810;#31181;#36873;#25321;#12290;#22312;#22797;#26434;#24615;#30333;#20869;#38556;#25163;#26415;#12289;#22806;#20260;#25110;#36951;#20256;#24615;#30142;#30149;#65288;#22914;#39532;#20961;#27663;#32508;#21512;#24449;#25110;#20551;#24615;#33073;#33853;#65289;#30340;#30333;#20869;#38556;#25163;#26415;#20013;#65292;#21487;#33021;#20250;#20986;#29616;#26230;#29366;#20307;#22218;#33180;#32570;#22833;#30340;#24773;#20917;#12290;#32780;#20809;#23398;#27835;#30103;#25514;#26045;#65288;#20329;#25140;#26694;#26550;#30524;#38236;#25110;#38544;#24418;#30524;#38236;#65289;#20197;#21450;#25163;#26415;#26041;#27861;#65288;#32467;#21512;#20351;#29992;#21069;#25151;#12289;#34425;#33180;#22266;#23450;#25110;#24041;#33180;#22266;#23450;#30340;#20154;#24037;#26230;#29366;#20307;#65289;#21487;#20197;#35299;#20915;#38382;#39064;#12290;#33258;#50;#48;#19990;#32426;#56;#48;#24180;#20195;#39318;#27425;#21457;#34920;#20851;#20110;#24041;#33180;#20869;#22266;#23450;#26415;#30340;#25991;#31456;#20197;#26469;#65292;#26893;#20837;#32463;#24041;#33180;#32541;#32447;#22266;#23450;#20154;#24037;#26230;#20307;#30340;#22806;#31185;#25216;#26415;#32463;#21382;#20102;#21508;#31181;#21508;#26679;#30340;#25913;#36827;#12290;#28982;#32780;#65292;#23613;#31649;#22806;#31185;#25163;#26415;#25216;#26415;#26377;#20102;#36827;#27493;#65292;#20294;#30001;#20110;#30740;#31350;#20026;#22238;#39038;#24615;#12289;#26679;#26412;#37327;#23567;#21644;#26368;#37325;#35201;#30340;#38543;#35775;#26102;#38388;#30701;#65292;#30740;#31350;#32467;#26524;#19981;#23613;#20154;#24847;#12290;#26412;#32508;#36848;#26088;#22312;#28145;#24230;#25506;#35752;#32463;#24041;#33180;#32541;#32447;#22266;#23450;#20154;#24037;#26230;#29366;#20307;#26893;#20837;#26415;#30340;#36827;#23637;#65292;#24182;#23545;#20170;#21518;#30340;#21457;#23637;#26041;#21521;#25552;#20986;#24314;#35758;#12290.

To describe clinical features of patients with diabetes mellitus-associated uveitis (DMAU).Retrospective analysis of clinical records of patients with uveitis and diabetes mellitus (DM) presented in an uveitis referral centre in Chile. Demographic data, comorbidities, complete ophthalmic examination, and treatments were analyzed.We found 72 patients with uveitis and DM: 16 with DMAU and poorly regulated DM (22%), 15 with DMAU and well-controlled DM (21%), and 41 with uveitis due to established other causes than DM (57%). Patients with DMAU in poorly regulated diabetes, presented inflammation of 3-4+ cells in 33%, a fibrinous reaction in 28%, hypopyon in 17% and posterior synechiae in 83%, compared with 5%, 0%, 0%, and 50% in the group with well-controlled DM, respectively (p 0.05). Most DMAU patients responded well to topical or periocular steroids.Patients with DMAU with poorly regulated DM present a more severe inflammation compared with patients with DMAU with well-controlled DM.

To describe, evaluate, and identify the characteristics, prognostic factors, and visual outcomes in patients with intraocular foreign body (IOFB) in a Latin American population. A retrospective, observational case-series of patients with a diagnosis of IOFB. Variables analyzed included age, gender, initial and final best correct visual acuity (BCVA), ocular trauma score, intraocular pressure, mechanism of injury, material and number of IOFB, zone of injury, timing of primary repair and IOFB removal, complications, and follow up. Sixty-one patients with IOFB were identified of which 97% were male with a mean age of 37.9 years (SD 2.16). The most common IOFB location was intravitreal (43%). IOFBs were metallic in 78%, vegetal in 3%, and other materials in 11%. Primary repair and secondary IOFB removal were performed at a mean timepoint of 3 days and 5 days, respectively. Systemic and topical antibiotics were administered to all patients. The initial BCVA was 1.62 logMAR and the final was 0.6 logMAR, which was statistically significant (Pearson’s chi-squared test, p value 0.01). No cases of endophthalmitis were seen. IOFB removal can be delayed when there are no signs of infection or evidence of retinal detachment, without an increased risk of endophthalmitis and a negative impact on visual outcomes. Use of topical and systemic antibiotics appear sufficient to prevent endophthalmitis in these cases.

Ligneous conjunctivitis is an uncommon and recurrent type of chronic conjunctivitis. A prevalent cause of this disease is a Plasminogen deficiency, resulting from recessive mutations in the human encoding plasminogen (PLG) gene. This deficiency affects the conjunctiva and also other mucous membranes. Only few hundred cases have been reported in the literature. Here we report a case of a 9-year-old boy with diagnosis of ligneous conjunctivitis. Histopathological examination in hematoxylin-eosin (HE) staining and sequencing of PLG gene were performed to confirm diagnosis. Histopathological findings confirmed the diagnosis of ligneous conjunctivitis. The patient is compound heterozygous for c.1026T>G (p.Val342Gly) and c.2384G>C (p.Arg795Pro) mutations in PLG gene. Both mutations have not been described previously, and the bioinformatic analysis strongly suggests that are causative of the disease. To the best of our knowledge, this is the first case report of a Chilean patient with ligneous conjunctivitis.

Background If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists. Aim To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service. Material and methods Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management. Results Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment. Conclusions This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

Aims: The aim of the study is to describe and evaluate the clinical features, multimodal imaging, differential diagnoses, treatment options, and visual outcomes in patients with diagnosis of uveal effusion syndrome (UES). Materials and Methods: This was a retrospective, observational case series of patients with diagnosis of UES. Variables analyzed included age, gender, medical history, initial and final best-corrected visual acuity (BCVA), clinical features, type of treatment, and follow-up. Results: We report three cases, consisting of 2 males and 1 female, aged 37, 58, and 72 years with the diagnosis of UES. One patient was treated with medical therapy (acetazolamide) and the other two were submited to surgical treatment including one case of two-thirds thickness sclerotomy and one case with subscleral sclerectomy. All cases had complete resolution of subretinal fluid (SRF). BCVA improved in two cases, while there was no improvement of BCVA in one case due to outer retina atrophy as a consequence of chronic SRF. Conclusions: The diagnosis of UES still remains a challenge for a clinician. It is essential to know the clinical features differential diagnosis and be familiarized with the different therapeutic approaches to establish accurate diagnosis and treatment.

If we are able to increase the resolution of complex medical problems at primary health care levels, we would improve the efficiency of the health care systems and would reduce the burden of specialists.To describe the result of a telemedicine and network management of diabetic retinopathy supervised by an ophthalmological service.Diabetic patients attended in primary health care centers of the East Metropolitan Health Service in Santiago, Chile, derived for 45° digital retinographies were evaluated using telemedicine by the ophthalmologists of the base hospital. These professionals screened for diabetic retinopathy and classified it. Those patients with diabetic retinopathy were derived to the base hospital for specialized management.Of 2,566 patients evaluated, 22% had signs of diabetic retinopathy, 75% did not have the condition and 2% could not be evaluated with retinography. Seventy percent of patients with retinopathy, equivalent to only fifteen percent of total diabetics, were referred to the specialists for treatment.This model allowed a reduction of referrals to ophthalmologists, reducing the burden of secondary and tertiary health care systems.

The purpose is to report a case of horseshoe macular tear and its management. Case reports of a patient with blunt trauma including findings on clinical examination, color fundus photography, and spectral-domain optical coherence tomography (OCT). A 23-year-old presented with a blunt ocular trauma from a plastic toy in the right eye. Fundoscopy revealed a horseshoe macular tear associated with a partial posterior vitreous detachment (PVD). OCT confirmed a full thickness macular tear with radial extension and associated retinal thickening. The patient underwent conservative management and was followed closely showing a spontaneous resolution of the macular tear. Our case report describes an example of traumatic horseshoe macular tear; we hypothesized that the PVD and the secondary inflammation as a result of the trauma were responsible for the spontaneous resolution of macular tear in our case.