Spontaneous Rotation of a Toric Implantable Collamer Lens

We present a case of toric implantable collamer lens (TICL) spontaneous rotation in a patient with myopic astigmatism. A 23-year-old female underwent TICL implantation. Preoperative uncorrected visual acuity (UCVA) was 20/800 and 20/1200, respectively, with −7.75 −4.25 × 0° and −8.25 −5.25 × 180°. The left eye achieved an UCVA of 20/30. After 3 months of successful implantation of TICL in the left eye, the patient presented with a sudden decrease in visual acuity in the left eye. UCVA was 20/100 with a refraction of +2.50 −4.50 × 165°. We observed the toric marks with a 30° rotation from the original position and decided to reposition the TICL, obtaining a final UCVA of 20/25, which remained stable at 6 months' follow-up. TICL can present a considerable rotation that compromises visual acuity. The relocation of TICL is a safe and effective procedure to recover visual acuity due to significant spontaneous TICL rotation

Perfil microbiológico y sensibilidad a antibióticos de microorganismos aislados de infecciones conjuntivales en el Instituto de Oftalmología Fundación Conde de Valenciana. Reporte del año 2012

ResumenIntroducciónLa conjuntiva es el tejido ocular que se infecta con mayor frecuencia. Los agentes patógenos más frecuentes de la conjuntivitis suelen ser los virus y las bacterias. El uso indiscriminado de antibióticos de amplio espectro para tratar la conjuntivitis ha generado microorganismos resistentes.ObjetivoIdentificar los microorganismos más frecuentes aislados de muestras de origen conjuntival y conocer su susceptibilidad antibiótica.Material y métodosRevisión retrospectiva de cultivos provenientes de raspados conjuntivales obtenidos durante el 2012.ResultadosSe obtuvieron 44 muestras de origen conjuntival. Estas provinieron de 21 varones y 23 mujeres. La mediana (25%, 75%) de la edad fue 62 años (39-68). El cultivo fue positivo en 13 de las muestras obtenidas, identificándose 5 microorganismos diferentes. Staphylococcus epidermidis fue el microorganismo aislado con mayor frecuencia (9 cepas). Todas las cepas de S. epidermidis fueron sensibles a vancomicina, gentamicina, cefotaxima, moxifloxacino y ofloxacino. La mayoría de las cepas de S. epidermidis (6/9) mostraron resistencia a múltiples antibióticos.ConclusionesStaphylococcus epidermidis fue el microorganismo aislado con mayor frecuencia en muestras provenientes de infecciones conjuntivales. Todas las cepas de S. epidermidis fueron sensibles a vancomicina, gentamicina y moxifloxacino y la mayoría de ellas fueron multirresistentes a los antibióticos en evaluación.AbstractIntroductionThe conjunctiva is the tissue of the eye that gets infected with more frequency. The most common pathogens of conjunctivitis are viruses and bacteria. The indiscriminate use of broad-spectrum antibiotics to treat conjunctivitis generated resistant microorganisms.ObjectiveIdentify the most common microorganisms isolated from samples of conjunctival origin and know their antibiotic susceptibility.Material and methodsRetrospective review of culture from conjunctival swabs obtained during 2012.ResultsWe collected 44 samples of conjunctival origin. They came from 21 males and 23 women. The median (25%, 75%) of age was 62 years (39-68). The culture was positive in 13 samples, identifying five different microorganisms. Staphylococcus epidermidis was the most common isolated microorganism (9 strains). All strains of S. epidermidis were sensitive to vancomycin, gentamicin, cefotaxime, ofloxacin and moxifloxacin. The multiple antibiotic resistance was identified in the majority of strains of S. epidermidis (6/9).ConclusionsStaphylococcus epidermidis was the most common isolated microorganism from samples of conjuntival infections. All strains of S. epidermidis were sensitive to vancomycin and moxifloxacin and most of them showed multidrug resistance to antibiotics

Herpetic Keratitis: A review of the evidence

Herpetic eye disease remains a major cause of corneal blindness, with an estimated incidence between 5.9 to 20 /105 of the population per year, with a prevalence of approximately 149/105 individuals in developed countries. Of the eight herpes viruses known to infect humans, only five cause significant ocular disease and include herpes simplex types I and II, varicella zoster, cytomegalovirus and Epstein- Barr virus . Humans are the only known reservoir for HSV and although its epidemiology has changed, it is generally accepted that its prevalence increases with age and can be identified in the trigeminal ganglia of over 90% of the population 60 years or older. Despite infecting most humans, ocular disease affects less tan 1% of the exposed population

Minor ipsilateral simple limbal epithelial transplantation (mini-SLET) for pterygium treatment

We describe a novel surgical technique for pterygium removal taking advantage of the properties of amniotic membrane and limbal epithelial stem cells. A total of 10 eyes underwent pterygium excision with amniotic membrane coverage of the bare sclera and placement of pieces of limbal epithelium in a linear fashion in the affected limbal area covered by a second amniotic membrane using fibrin glue. After up to 8 months of follow-up, there were no signs of early recurrence or sight-threatening complications. The minor ipsilateral simple limbal epithelial transplantation technique for the treatment of pterygium requires less tissue than the conventional conjunctival autograft, leaving healthy conjunctiva if needed for another procedure in the future and offers the advantages of epithelial stem cells, which in the long term may reduce the rate of recurrence significantly

Intraoperative flap complications in lasik surgery performed by ophthalmology residents

Purpose: To report the rate of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and to analyze the risk factors for these complications. Methods: We analyzed 273 flap dissections in 145 patients from March 2013 to February 2014. We included all LASIK surgeries performed by 32 ophthalmology residents using a Moria M2 microkeratome. All the flap-related complications were noted. Comparison between both groups with and without complications was performed with an independent Student's t-test and relative risks were calculated. Results: There were 19 flap-related complications out of the 273 flap dissections (6.95%). The most common complication was incomplete flap dissection (n = 10; 3.66%), followed by free-cap (n = 5; 1.83%), and flap-buttonhole (n = 2; 0.73%). There was no significant difference between the complicated and uncomplicated cases in terms of the right versus the left eye, pachymetry results, white-to-white diameter, and spherical equivalent. But this difference was significant for mean keratometry (P = 0.008), K-min (P = 0.01), and K-max (P = 0.03) between these groups. Final visual acuity after rescheduling laser treatment was similar in both groups. Relative risks for flap-related complications were 2.03 for the first LASIK surgery (CI 95% 0.64 to 6.48; P = 0.22) and 1.26 (CI 95% 0.43 to 3.69; P = 0.66) for the surgeon's flap-related complications. Female gender presented an odds ratio of 2.48 (CI 95% 0.68 to 9.00; P = 0.16) for complications. Conclusion: Flap-related complications are common intraoperative event during LASIK surgery performed by in-training ophthalmologists. Keratometries and surgeon's first procedure represent a higher probability for flap related complications than some other biometric parameters of patient's eye

Dry eye symptoms and associated risk factors among adults aged 50 or more years in Central Mexico

Objective. To determine the prevalence of dry eye symp­toms (DES) and associated risk factors among adults in Tlax­cala, Mexico. Materials and methods. A cross-sectional population-based study that included 1 508 individuals aged ≥50 years who answered the Dry Eye Questionnaire (DEQ- 5), with a score ranging between 0 and 22; the following categories were defined: no DES (<6); mild-moderate DES (6 to 11) and severe DES (≥12). Results. The prevalence of DES was 41.1% (95%CI 38.6-43.6), and was higher in women (OR=2.26, 95%IC 1.70-3.00), in individuals with smoking in­dex of <10 (OR=1.40, 95%CI 1.05-1.87) and ≥10 pack-years (OR=2.29, 95%CI 1.44-3.63), compared to never-smokers, subjects with history of ever consuming alcohol (OR=1.31, 95%CI 1.02-1.70), and those receiving antihypertensive treat­ment (OR=1.29, 95%CI 1.00-1.65). Conclusion. Dry eye symptoms were highly prevalent in the study population and were associated with sex, smoking, alcohol consumption, and antihypertensive medications

Low Expression of IL-10 in Circulating Bregs and Inverted IL-10/TNF-α Ratio in Tears of Patients with Perennial Allergic Conjunctivitis: A Preliminary Study

Allergic conjunctivitis (AC) is one of the most common ophthalmological disorders seen in clinical practice. Growing evidence from recent years suggests that a subset of IL-10-expressing B cells is involved in inflammatory allergic diseases. In this study, we aimed to evaluate the potential involvement of blood Bregs cells in perennial allergic conjunctivitis (PAC), and interleukins (IL)-1&#946;, IL-6, IL-8, IL-10, and IL-12, and tumor necrosis factor (TNF)-&#945;, were measured in tear samples and compared with healthy controls (HC) using flow cytometry. Non-significant differences in CD19+IL-10+ cell frequency between PAC patients and healthy controls (HC) were observed. Nevertheless, when we analyzed the mean fluorescence intensity (MFI) of IL-10 on CD19+CD38Lo/Med/Hi-gated cells, we observed a significant decrease in MFI in all Bregs subsets in PAC patients. Additionally, tear cytokines showed 2.8 times lower levels of IL-10 than TNF-&#945; in PAC patients when compared to HC. Our findings demonstrate an immunological dysregulation in patients with allergic conjunctivitis, characterized by the low expression of IL-10 in circulating CD19+CD38+ Bregs subsets and an inverted tear IL-10/TNF-&#945; ratio, promoting a local pro-inflammatory microenvironment. These findings highlight the novel pathologic changes involved in ocular allergic diseases. Understanding systemic and local mechanisms will aid the design of immunomodulating therapeutics at different levels