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Abstract Background To describe the anatomical and functional outcomes and late complications in patients who developed inferior proliferative vitreoretinopathy (PVR) in silicone oil-filled eyes and who required reoperation with large inferior retinectomy. Methods This is a single-center, retrospective, interventional case series analysis. The study involved 18 individuals with tractional retinal re-detachment due to PVR development inferiorly in eyes who had undergone prior pars plana vitrectomy and silicone oil as a tamponade. All patients included in the study underwent secondary surgery with large inferior retinectomy (from 120° to 270°) and silicone oil filling. Results The mean follow-up period was 44.0 ± 31.5 (± SD) months (range: 4 to 96 months. The anatomical success, defined as the complete reattachment of the retina until the last follow-up, was observed in 88.9% of the cases. The postoperative visual acuity ranged from 20/100 to hand motion at 60 cm. Only two cases (11.1%) did not achieve anatomical success at the last follow-up due to recurrent PVR and retinal re-detachment (one including hypotony). All of the patients were pseudophakic. The PVR grade, as well as the presence of PVR prior to primary surgery, showed no statistical correlation with BCVA, the extent of retinectomies, and final macular status. There was a statistically significant correlation between "Final BCVA" and "Initial BCVA" (r = 0.654) and between "Final BCVA" and "Extent of Retinectomy" (r = 0.615). Conclusions Reoperation in eyes filled with silicone oil may be required when PVR is developed. Secondary surgery in these cases with large inferior retinectomy and silicone oil implantation may reach good anatomical success with low rates of late complications, besides improving visual acuity. A better BCVA at the time of re-RD diagnosis and cases of retinectomies with greater extensions showed a positive correlation with better functional outcomes. Trial registration Research Ethics Committee of the Suel Abujamra Institute reviewed and approved this study protocol (approval number, 5.404.961).

Abstract Purpose To describe a rare case of a 13 years-old healthy child that presented CRAO secondary to carotid artery dissection, which occurred after a neck rotation movement. Methods Case report with prospective literature review. Patients One patient described in the case report. Results Not applicable. Discussion/conclusion Internal carotid artery dissection is a rare condition, specially in children, that can lead to serious cerebral-ocular ischemic events. It may occur due to direct vessel trauma or spontaneously. Prompt imaging screening is of paramount importance because early antithrombotic treatment or surgical intervention may significantly reduce the incidence of devastating ischemic events, such as stroke or central retinal artery occlusion.

Abstract Purpose The aim of this article is to report a rare case in which a patient presented symptomatic silicon oil brain migration, documented by MRI, several years after vitreoretinal surgery. Methods This is a case report with a prospective literature review. Patients The patient described in the case report. Results Case report. Discussion/conclusions For several years, silicone oil (SiO) has been widely used as a long-term intravitreal tamponading agent to treat complex retinal detachments. There are rare reports in the literature demonstrating the migration of SiO into the brain. The aim of this article is to report a rare case in which the patient presented severe headaches several years after vitreoretinal surgery, with migrated SiO appearing in MRI as an oval lesion within the horn of the right lateral ventricle. To the best of our knowledge, there are very few reports of symptomatic SiO brain migration in the literature.

Abstract Diffuse unilateral subacute neuroretinitis (DUSN) is an ocular infectious disease that can lead to severe visual impairment and blindness. It usually occurs in healthy young individuals and depending on the stage of the disease, it may present as vitritis, multifocal gray-white lesions in the outer retina, and derangement of the retinal pigment epithelium, narrowing of the retinal vessels and optic atrophy. Parasites of different sizes and species have been proposed as the etiologic agent of DUSN, including Ancylostoma caninum, Toxocara canis, and others. Thus, it is hypothesized that different infectious worms may be considered as the likely cause of both an autoimmune and toxic form of nematode retinopathy. Because serologic testing is variable, the definitive diagnosis is made when clinical characteristics of DUSN are found in conjunction with an intraocular worm. Ancillary tests can assist in the differential diagnosis when the nematode cannot be visualized, such as fluorescein and indocyanine green angiography, electrophysiological tests, visual field studies, and more recently, optical coherence tomography angiography. Cases in which the worm can be identified, it is defined as confirmed DUSN, and eyes with the typical clinical features but without identification of the worm should be classified as presumed DUSN. In confirmed DUSN, the classic treatment is directly photocoagulation of the worm; however, it can only be visualized in 30% (to 40%) of cases. Treatment of presumed DUSN cases with high-dose oral albendazole has shown encouraging results. However, perhaps due to the disease’s rarity or its underdiagnosis, there are no studies comparing current treatment modalities in both presumed and confirmed DUSN. Due to the possibility of this disease being, in part, autoimmune nematode retinopathy, corticosteroids associated with both albendazole or laser therapy, could be in any way beneficial. Thus, further comparative studies are necessary to elucidate the best treatment for this potentially blinding disease.

Abstract Purpose: To investigate the patients’ perspectives regarding the introduction of the electronic medical record into use in an ophthalmologic hospital and its impact on the doctor/patient relationship. Methods: The cross-sectional study analyzed the impact of the electronic medical record on the doctor-patient relationship based on the patients’ opinions after electronic medical record implementation compared with use of traditional paper records. The same doctor attended all patients and completed questionnaires during patient interviews that analyzed empathy, punctuality, efficiency, information clarity, doctor cordiality, respect, trustworthiness, patient benefits from the technology, confidentiality, and humanized care. The inclusion criteria included age of 18 years or older, adequate cognition, previous treatment in the same institution by the same doctor using paper medical records and later the electronic medical record, and free and informed written patient consent. The exclusion criteria included age below 18 years, inadequate time to answer the questionnaire, first patient visit, doubtful interview responses, and first visit before 6 months after electronic medical record implementation. The data were analyzed descriptively by relative and absolute frequencies. A previous pilot study of 20 patients yielded 95% confidence intervals for the percentages of agreement for the electronic medical record questionnaire responses obtained and found that 160 patients was adequate for performing the study. Results: The patients reported that the electronic medical record had a positive impact on the doctor-patient relationship in all areas considered. Over 94% of patients responded affirmatively when questioned about their confidence in the confidentiality of their data, 38.3% noted changes in the doctor’s concern for service and 68% agreed that clarity of the information provided by the doctor was greater with the electronic medical record. Conclusion: Based on the patients’ perceptions, the EMR positively affected the doctor-patient relationship after the implementation of the technology in a private ophthalmologic hospital.

Resumo Objetivo: Revisar criticamente a literatura sobre o implante intraocular da Lente Macular Scharioth (SML) em pacientes com estágios avançados de Degeneração Macular Relacionada à Idade (DMRI). Métodos: A pesquisa bibliográfica foi feita nas bases de dados do Pubmed e Google Acadêmico, com os termo dry AMD, devices e Scharioth Macula Lens. Utilizamos os artigos prospectivos, retrospectivos ou relatos de casos publicados em inglês ou português nos últimos cinco anos, com esses termos. Resultados: Foram encontrados um total de 19 artigos, todos em inglês. Sendo que destes, 5 relacionavam-se a complicações da cirurgia de catarata e outro à degeneração macular exsudativa e foram excluidos. Portanto, foram utilizadas 13 referências para esta revisão. Conclusão: A Scharioth Macula Lens foi desenvolvida como lente intraocular suplementar para olhos pseudofácicos com DMRI, mas vem sendo usada também em pacientes com outra maculopatias. Os resultados iniciais relatados são animadores.

Resumo Objetivo: Realizar uma revisão sobre o diagnóstico do ceratocone, com enfoque nos métodos propedêuticos disponíveis. Métodos: Foi realizada uma pesquisa no banco de dados PubMed com as palavras chave: Keratoconus, diagnosis, topography e tomography. Por se tratar de uma revisão, não houve restrição de período para a publicação dos artigos selecionados. Foram também utilizados o manual Prefered Practice Pattern(PPP) da academia americana de oftalmologia, assim como o site “eyewiki.aao.org”. Resultados: Dos 641 artigos encontrados no PubMed, assim como os usados como referência para o PPP, 36 foram selecionados por serem considerados mais relevantes para o tema proposto. O site “eyewiki.aao.org” foi utilizado como referência para as figuras. Conclusão: O diagnóstico do ceratocone evoluiu consideravelmente desde quando foi primeiramente descrito. É desejável que seja feito em suas fases precoces devido ao alto potencial de morbidade desta doença. Uma possível integração entre os múltiplos índices diagnósticos, investigação genética, biologia molecular e inteligência artificial é almejado para uma maior acurácia diagnóstica.

RESUMO O artigo tem como objetivo descrever de forma prospectiva diferentes casos de ectasias altamente assimétricas (very asymmetric ectasia, VAE) para diferenciar formas subclínicas ou "frustas" do ceratocone (forme fruste keratoconus - FFKC) de casos de doença ectásica unilateral. O Caso 1 é um paciente de 39 anos, que admitiu ter coçado intensamente apenas o olho direito (OD) na juventude, se apresentando com ectasia unilateral tratada com sucesso por meio de implante de anel intraestromal em OD. O olho esquerdo (OE) apresentou-se normal ao exame completo por meio de propedêutica multimodal e acuidade visual não corrigida (AVsc) de 20/20, estável por mais de 5 anos, com TBI (tomography and biomechanical index) de 0.02. No Caso 2 é um paciente de 15 anos com ectasia clínica em OD, e OE com topografia normal, mas alterações tomográficas e biomecânicas, incluindo o TBI 0,56, caracterizarando a doença subclínica (FFKC). O Caso 3 é a mãe do paciente do Caso 2, de 46 anos, que se apresentou com presbiopia, sem qualquer histórico oftalmológico relevante. A AVsc foi de 20/20 em cada olho, topografia de Placido com leve encurvamento inferior, mas sem sinais definitivos de ectasia. A avaliação biomecânica e tomográfica revelou sinais de ceratocone em ambos os olhos, com TBI de 1,0 e 0,99. Esses três casos estão de acordo com a definição do consenso global e a hipótese de dois acertos (two-hit hypothesis), que ceratocone é uma doença bilateral, mas ectasia pode ocorrer por causa estritamente mecânica unilateralmente (ou em qualquer olho). A relevância da propedêutica multimodal é destacada, destacando-se a integração do estudo biomecânico e tomográfico com imagens de Scheimpflug.