Evolution of optic nerve and retina alterations in a child with indirect traumatic neuropathy as assessed by optical coherence tomography

Herein, we describe the case of a 4-year-old child with indirect traumatic optic neuropathy and serial changes of the optic nerve head and retinal nerve fiber layer (RNFL) documented using optical coherence tomography (OCT). Visual acuity improved despite progressive RNFL thinning and optic disc pallor. We concluded that OCT may be useful for monitoring axonal loss but may not predict the final visual outcome.Univ Miami, Miller Sch Med, Bascom Palmer Eye Inst, Dept Ophthalmol, 900 NW 17th St, Miami, FL 33136 USAUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, SP, BrazilWeb of Scienc

Tricomegalia essencial: relato de caso

The present study reports two cases of symptomatic essential trichomegaly. Trichomegaly may develop in various diseases, including anorexia nervosa, hypothyroidism, pregnancy, pretibial myxedema, systemic lupus erythematosus, vernal keratoconjunctivitis, and uveitis. The exact incidence trichomegaly is unknown, and the condition remains sporadically reported. Two cases of symptomatic trichomegaly without any associated systemic disorder are presented in this paper.O presente estudo tem por objetivo relatar dois casos de tricomegalia essencial com diminuição da acuidade visual. A tricomegalia pode se desenvolver em várias doenças, incluindo anorexia nervosa, hipotireoidismo, gravidez, mixedema pré-tibial, lúpus eritematoso sistêmico, ceratoconjuntivite primaveril, e uveíte. A incidência da tricomegalia essencial é desconhecida e a condição permanece esporadicamente relatada. São apresentados dois casos de tricomegalia sintomática em pacientes sem distúrbios sistêmicos associados.Universidade Federal de São Paulo (UNIFESP) Department of OphthalmologyUNIFESP, Department of OphthalmologySciEL

Acurácia Da Medida Da Distancia Do Limbo À Inserção Da Musculatura Ocular Extrínseca Com Tomografia De Coerência Óptica Em Cirurgias De Estrabismo

Purpose: To assess the accuracy of anterior segment optical coherence tomography (AS-OCT) in measuring the distance of extraocular muscle (EOM) insertion to the limbus to improve preoperative assessment of adult patients undergoing strabismus surgery. Methods: A reliability analysis at an institutional practice performed in adult patients scheduled for strabismus surgery on rectus muscles. The distance between the EOM insertion and the limbus was measured preoperatively with AS-OCT. The value was compared to intraoperative measurement obtained with calipers. Additional measurements included the limbus-anterior chamber angle distance with AS-OCT and the axial length with IOLMaster. The main outcome measure was the greement between preoperative AS-OCT and intraoperative measurements. A difference of ≤ 1 millimeter (mm) was "clinically acceptable". Results: 144 muscles were analyzed from 74 patients. 31 of 33 reoperated muscles were successfully imaged. AS-OCT measurements were within 1 mm of intraoperative measurements in 77% of all the muscles. The accuracy was higher for muscles with no prior surgery (83%), as compared to re-operated muscles (58%). Although the accuracy decreased when comparing reoperations to primary surgeries for the medial (79 to 63%; p=0.09; 95%CI, -1.38 to 0.11) and the lateral rectus (81 to 49%; p=0.11; 95%CI, -2.06 to 0.22), the difference was not significant. No correlation between limbus-anterior chamber angle distance and axial length was established. Conclusions: AS-OCT is valuable in identifying EOM insertions in primary strabismus surgeries, but the accuracy decreases in re-operations. The intraoperative measure performed before the detachment of the muscle's tendon and the use of limbus as a reference point in the OCT proved to be suitable for performing the measurements.Objetivo: Avaliar a precisão da tomografia de coerência óptica de segmento anterior (AS-OCT) ao medir a distância entre a inserção dos músculos extraoculares e o limbo, visando melhorar a avaliação pré-operatória de pacientes adultos a serem submetidos a cirurgia primária ou repetida de estrabismo. Métodos: Estudo prospectivo, mascarado, realizado em pacientes adultos (> 18 anos) agendados para cirurgia de estrabismo e intervenção nos músculos retos horizontais e/ou verticais. A distância entre a inserção da musculatura e o limbo (em milímetros) foi medida no pré- operatório com AS-OCT (OCT Visante) e seu valor foi comparado à medida peroperatória obtida com compasso cirúrgico. Uma diferença ≤ 1 milímetro foi considerada "clinicamente aceitável". Medições adicionais foram obtidas, incluindo a distância a partir do limbo ao ângulo da câmara anterior com AS-OCT e o comprimento axial do olho com biometria óptica (IOLMaster). Resultados: Foram analisados 74 pacientes e um total de 144 músculos, incluindo 31 músculos já submetidos previamente a cirurgia (reoperação). As medições com AS-OCT diferiram em menos de 1 mm das medidas peroperatórias em 77,1% dos músculos. A precisão foi maior para os músculos sem cirurgia anterior (83,2%), quando comparadas com os músculos reoperados (58,1%). Não foi demonstrada relação entre o comprimento axial do olho e a distância entre o limbo e o ângulo da câmara anterior (p > 0,05) para todos os músculos retos). Conclusão: A tomografia de coerência óptica foi considerada um método acurado para a avaliação da distância entre o limbo e a inserção dos músculos retos em toda a amostra constituída de olhos submetidos a cirurgia primária e/ou reoperação e isoladamente para aqueles submetidos apenas a cirurgia primária. O mesmo método não apresentou a mesma acurácia para o grupo com cirurgia prévia de estrabismo. A medida peroperatória antes da desinserção do tendão e o uso do limbo como ponto de referência na tomografia de coerência óptica mostraram-se adequados para a realização das medidas.Dados abertos - Sucupira - Teses e dissertações (2017

Autoimmune Retinopathy, Testing, and Its Controversies

Purpose of Review The purpose of this revision is to sumarize the most important clinical features of the autoimune retinopathies (AIRs). Recent Findings AIRs are a group of inflammatory conditions affecting the retina characterized by progressive unexplained visual loss, abnormalities and contraction in visual fields, photoreceptor and electroretinographic dysfunction, and the presence of circulating anti-retinal antibodies. The pathogenesis of AIR remains unclear and various antiretinal antibodies have been associated to the disease. The diagnosis of AIR is based on a particular clinical presentation along with the detection of serum antiretinal antibodies. Numerous anti-inflammatory therapeutic alternatives have been described for the treatment of AIR; nevertheless, there is no consensus on treatment protocol. Summary Because of its association with different types of malignant tumors, the early diagnosis, multi-disciplinary approach, and prompt treatment should be warranted

Treatment of cystoid macular edema secondary to chronic non-infectious intermediate uveitis with an intraocular dexamethasone implant

ABSTRACT Purpose: To evaluate the use of a slow-release dexamethasone 0.7-mg intravitreal implant for cystoid macular edema (CME) secondary to intermediate uveitis and refractory to systemic steroids. Methods: A retrospective study of the best-corrected visual acuity (BCVA), intraocular inflammation, intraocular pressure (IOP), fundus photography, optical coherence tomography (OCT), inflammation, and adverse reactions of five patients (women, mean age of 35 years) with cystoid macular edema treated with a dexamethasone implant. Patients were evaluated in seven visits until the 150th day after the implant. Results: Four patients had bilateral pars planitis and one had bilateral intermediate uveitis associated with juvenile idiopathic arthritis. Six dexamethasone devices were implanted, under topical anesthesia (one each in six eyes, five patients). The mean follow-up time was 5 months. The best-corrected visual acuity improved in all eyes that received an implant, with five having improvements of two or more lines. Optical coherence tomography showed thinning of the macula in all eyes treated, and we saw a correlation between the best-corrected visual acuity and retinal thinning. No serious adverse events occurred and no significant increase in intraocular pressure was observed. Conclusions: Slow-release dexamethasone intravitreal implants can effectively treat CME secondary to intermediate uveitis and refractory to systemic steroids

Evaluation of Postoperative Povidone-Iodine in Adjustable Suture Strabismus Surgery to Reduce Suture Colonization A Randomized Clinical Trial

IMPORTANCE Although the association between suture colonization and postoperative infections remains hypothetical, measures to reduce perioperative suture colonization may minimize postoperative infections. The suture colonization rate in adjustable suture strabismus surgery is not well defined, and the effect of povidone-iodine use on suture colonization is unknown. OBJECTIVE To assess whether povidone-iodine application at the end of adjustable suture strabismus surgery decreases the suture colonization rate. DESIGN, SETTING, AND PARTICIPANTS In this randomized clinical trial designed in 2015 and performed from June 1 through October 31, 2015, a total of 65 adjustable and 43 control suture specimens from 65 demographically similar adults undergoing adjustable suture strabismus surgery were studied. A random sampling assigned participants into group 1 (with povidone-iodine) or group 2 (without povidone-iodine) at the end of surgery. A control suture specimen was obtained if ipsilateral nonadjustable surgery was performed. Both groups received antibiotic ointment at the end of the procedure. No patients refused participation or withdrew. Data analysis was performed from October 1 to December 31, 2015. Observers were unaware of patient grouping. INTERVENTIONS One drop of 5% povidone-iodine directly over the sliding noose of the adjustable suture at the end of surgery. MAIN OUTCOMES AND MEASURES The suture colonization rate after adjustment in group 1, group 2, and the control group. RESULTS Of 65 adults undergoing surgery, there were 17 men (49%) and 18 women (51%) in group 1 and 10 men (33%) and 20 women (67%) in group 2, as well as 20 men (47%) and 23 women (53%) in the control group. The mean (SD) age of the patients was 48.5 (16.8) years in group 1, 46.6 (18.1) years in group 2, and 47.7 (17.0) years in the control group. There was no difference in the colonization rate between group 1 (57%) and group 2 (47%) (relative risk [RR], 1.195% CI, 0.6-1.7P = .80), group 1 and the control group (44%) (RR, 1.095% CI, 0.5-1.8P > .99), or group 2 and the control group (RR, 1.395% CI, 0.8-2.1P = .62). Eleven bacterial species were identified. Staphylococcus epidermidis was the predominant isolate (40 of 56 [71%]). A longer interval between the end of surgery and adjustment was associated with higher culture positivity (6.3 hours in positive vs 4.4 hours in negative cultures, P = .001)however, there was no difference in bacterial growth between the groups. No adverse effects of povidone-iodine were observed. CONCLUSIONS AND RELEVANCE This study was not able to demonstrate that povidone-iodine at the end of adjustable suture strabismus surgery reduces the suture colonization rate.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)National Institutes of Health (NIH)Research to Prevent BlindnessUniv Miami, Miller Sch Med, Dept Ophthalmol, Bascom Palmer Eye Inst, 900 NW 17th St, Miami, FL 33136 USAUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilKhon Kaen Univ, Dept Ophthalmol, Fac Med, Khon Kaen, ThailandTel Aviv Univ, Div Ophthalmol, Tel Aviv Med Ctr, Sackler Fac Med, Tel Aviv, IsraelDepartment of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (UNIFESP), São Paulo, BrazilNIH: P30EY014801Web of Scienc

Paediatric infectious keratitis: a case series of 107 children presenting to a tertiary referral centre

Background/aims Corneal ulcers can result in severe visual impairment in children. The recent trends of paediatric microbial ulcerative keratitis in the USA are unknown. The purpose of this study is to report the risk factors, microbiological profile and treatment outcomes of paediatric microbial keratitis in South Florida. Methods A university-based tertiary eye care centre retrospective case series between 1992 and 2015. Medical records of 107 paediatric patients (age < 18 years) with the diagnosis of microbial ulcerative keratitis were analysed. Patient demographics, culture data, microbial susceptibility, management trends and patient outcomes were collected. Results Mean age of patients was 13 +/- 4.6 years (range 0.2-17 years). The most common associated risk factor was contact lens wear (77.6%), followed by ocular trauma (8.4%). Systemic factors were present in 4.7% of cases. Cultures were taken from 89 patients. A total of 74 organisms were isolated from the 52 corneal scrapings with growth, yielding a 58.4% positivity rate. Seventeen microbial species were identified, with a predominance of Pseudomonas aeruginosa (46.2%), followed by Stenotrophomonas maltophilia (19.2%) and Fusarium (13.5%). Combined fortified antibiotics were the most common treatment (51.4%). Mean follow-up time was 40.6 +/- 91.6 weeks (range: 0.3-480 weeks). The mean visual acuity improved from 20/160 to 20/50 (p<0.0001). No therapeutic penetrating keratoplasty was needed. Conclusions In this study, contact lens wear was the most frequent risk factor in infectious keratitis in children. P. aeruginosa was the most common microorganism present in our setting. The majority of the cases responded well to medical management.CAPES Foundation, Ministry of Education of Brazil, Brasilia, BrazilNIH Center Core GrantResearch to Prevent Blindness Unrestricted GrantUniv Miami, Miller Sch Med, Bascom Palmer Eye Inst, Dept Ophthalmol, 900 NW 17th St, Miami, FL 33136 USAUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilTel Aviv Univ, Sackler Fac Med, Tel Aviv Med Ctr, Dept Ophthalmol, Tel Aviv, IsraelUniv Fed Sao Paulo, Dept Ophthalmol & Visual Sci, Sao Paulo, BrazilNIH Center Core Grant: P30EY014801Web of Scienc