Patricia Chirinos-Saldaña

Objetivo: Caracterizar el perfil epidemiológico y clínico de la queratitis micótica (QM), y analizar las tasas de éxito de las modalidades de su tratamiento durante la década 2009-2018 en el Instituto Regional de Oftalmología de Trujillo, Perú. Materiales y métodos: estudio retrospectivo y descriptivo de datos extraídos de historias clínicas de pacientes con QM. Se estudiaron variables demográficas, clínicas, microbiológicas, factores de riesgo, modalidades de tratamiento y complicaciones. Se calcularon las tasas de éxito anual y global para el tratamiento médico (TM) y quirúrgico (TQ) de primera y segunda línea. Resultados: Se estudiaron 345 pacientes, la edad fue 44.4 +/- 16.6 años, el 75.4% fueron varones. El 90.4% reportaron uno o más factores de riesgo, siendo el más frecuente el trauma ocular (81.2%). Las úlceras fueron mayoritariamente centrales (61.5%). La positividad del cultivo fue del 35.8%, aislándose hongos filamentosos en el 92.3%. El TM fue la modalidad de tratamiento preferente y su uso se incrementó año tras año. El éxito global del TM, TQ de primera línea y TQ de segunda línea fue de 59.2%, 68.6% y 65.1%, respectivamente. Luego del TM y TQ, se alcanzaron agudezas visuales > 20/60 en el 43.3% y 8.8% de los casos respectivamente. Conclusiones: La QM predominó en adultos varones jóvenes con antecedente de trauma ocular. Las úlceras corneales comprometieron principalmente el eje visual. La positividad del cultivo fue baja, aislándose hongos filamentosos en la mayoría de los casos. El éxito del TQ fue superior al del TM, aunque resultando en peores agudezas visuales.

Objetivo: Determinar los factores relacionados al éxito anatómico y funcional de la cirugía por desprendimiento de retina regmatógeno (DRR) en pacientes del Instituto Regional de Oftalmología “Javier Servat Univazo”. Materiales y métodos: estudio observacional en una cohorte retrospectiva de 204 pacientes con DRR sometidos a diferentes técnicas quirúrgicas entre enero 2010-diciembre 2019, con al menos 6 meses de seguimiento. Las variables estudiadas fueron: éxito anatómico (reaplicación primaria de retina) y éxito funcional (mejoría de agudeza visual [AV]); buscándose asociación entre estas variables y las demográficas, clínicas y tiempos de espera. Resultados: La edad promedio fue 50 + 16,5 (9-85) años. Éxito anatómico, se alcanzó en 165 (80,9%) pacientes y funcional en 110 (52,9%). Hubo menor tiempo de espera quirúrgico en pacientes que lograron éxito anatómico (20,0 +/- 22,6 días [1-120]) vs (29,8 +/- 40,1 días [1-210]) (p=0,04) y en los que tuvieron éxito funcional ( 13,3+/- 15,1 [1-100]) vs (31,9 +/- 33,7 [1-210]) (p=0,0002); y menor tiempo de enfermedad y menor tiempo total en los que tuvieron éxito funcional (29,7 +/-56,5 días [1-365] vs (61,9 +/- 110,6 días [1-730]) (p= 0,008) y (43,1 +/-68,1 [5-465]) vs 93,8 +/- 118,3 [3-766]) respectivamente (p=0,0002). Conclusiones: El menor tiempo de espera quirúrgico mostró asociación con el éxito anatómico y funcional de la cirugía por DRR. El menor tiempo de enfermedad y el menor tiempo total mostraron asociación con el éxito funcional. Recomendamos implementar medidas para abreviar tiempos de espera e instaurar una terapia quirúrgica precoz y oportuna en estos pacientes.

To describe the epidemiology, etiology, pathogenesis, clinical characteristics, and management of pemphigus, with an emphasis on ocular involvement. Literature review. Pemphigus is an autoimmune epithelial blistering disease of the skin and mucous membranes. The typical pathological finding is acantholysis of the epidermis that leads to blister formation. Immunofluorescence techniques show autoantibody deposition on the epidermal intercellular substance. Although a genetic background is necessary, environmental factors are crucial for the onset and perpetuation of the disease. Exposure to some drugs, toxic agents, and foods and associations with other autoimmune diseases and lymphoproliferative conditions should be assessed. Generally, the skin is the most commonly affected tissue. Ocular involvement might be present and exhibit a clinical course that is independent of skin compromise. Visual function may be affected depending on the severity of the presentation. In untreated cases, mortality is high because of bacterial sepsis and hydroelectrolyte imbalance. A multidisciplinary approach should be used involving a dermatologist, ophthalmologist, and immunologist. Immunosuppressive agents are the mainstay of treatment; corticosteroids typically with azathioprine or mycophenolate mofetil are the drugs of choice. Surgical treatment of trichiasis and malposition of the eyelids and tectonic procedures for corneal perforation are sometimes required in very severe and recalcitrant cases. Pemphigus is a potential life- and sight-threatening disease. Understanding the disease facilitates the adequate assessment of the modifiable factors and the prompt initiation of immunotherapy. Ocular involvement can develop in patients with pemphigus. Adequate ophthalmological care is needed, in particular, prevention of infections, scarring, and corneal perforation.

PURPOSE: To assess the reliability of three different Scheimpflug systems and their agreement. METHODS: Eighty-four eyes of 42 patients were examined with three Scheimpflug devices: the Galilei G2 Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG, Port, Switzerland), Pentacam HR system (Oculus Optikgeräte GmbH, Wetzlar, Germany), and Sirius 3D imaging system (Costruzione Strumenti Oftalmici, Florence, Italy). The central corneal thickness, maximum anterior and posterior corneal elevation, anterior radius of curvature, total higher-order aberrations, and anterior chamber depth were evaluated. Repeatability and reproducibility were evaluated using coefficients of variation and intraclass correlation coefficients. Interdevice agreement was assessed by Bland–Altman comparison analysis. RESULTS: The three Scheimpflug systems had excellent repeatability for central corneal thickness, anterior radius of curvature, and anterior chamber depth (coefficients of variation being less than 1%). Repeatability for anterior and posterior corneal evaluation was good for the Pentacam HR and Galilei G2 (coefficients of variation < 10%) and excellent for the Sirius 3D (coefficients of variation = 0). Reproducibility was excellent in the three devices, (intraclass correlation coefficient of more than 0.9). Interdevice agreement was excellent ( P > .05) for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but was poor ( P < .05) for corneal elevation and higher-order aberrations. CONCLUSIONS: Reliability was good to excellent in the three devices for all measured variables. Interdevice agreement analysis suggests that measurements for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but not for maximum anterior and posterior corneal elevation and total higher-order aberrations, from the Sirius 3D and Galilei G2 can be interchangeable with the Pentacam HR. [ J Refract Surg. 2014;30(9):616–621.]

To describe the clinical characteristics of ocular involvement in patients with pemphigus at an ophthalmological referral center. A retrospective review was conducted on patients with the immunopathological diagnosis of pemphigus examined between 1 January 2000 and 1 April 2010. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BCVA), ocular symptoms, and ocular surface inflammatory and scarring changes were assessed. A total of 15 patients were identified, with a mean age of 68.27 ± 14.35 years, and 80% (n=12) were female. Extraocular involvement was reported in one patient. All of the eyes showed cicatricial changes in the conjunctiva. In all, 6 eyes (20%) were classified as stage I; 12 eyes (40%) as stage II; 10 eyes (33%) as stage III; and 2 eyes (7%) as stage IV. A statistically significant association was found between BCVA and the severity of ocular involvement. The mean BCVA logMAR was 1.66 (20/914), with a range from logMAR 0 (20/20) to logMAR 4 (NLP). Other ocular diseases were found in 8 (53.3%), systemic diseases in 10 (66.7%), and the use of pemphigus-inducing drugs in 10 patients (66.7%). The present report represents the largest series of ocular involvement in pemphigus confirmed by immunopathology. The clinical manifestations varied from conjunctival hyperemia to corneal scarring and perforation. There was a strong association between scarring changes and low BCVA. Ocular and systemic diseases as well as the use of pemphigus-inducing drugs may predispose to ocular cicatricial changes observed in this series.

Background: Infectious keratitis is a sight-threatening condition for children. The purpose of this study was to describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children.Methods: Retrospective review of clinical records of patients under 16 years of age with history of microbial keratitis seen at a tertiary referral center. Clinical characteristics, risk factors, visual and surgical outcomes as well as the microbiological profile are analyzed.Results: Forty-one eyes of 41 patients. Mean age was 8.7 years. Time between the onset of symptoms and ophthalmological examination was 12.7 days. Predisposing factors were found in 78%; ocular trauma was the most common (25%). Visual acuity equal or worse than 20/200 at admission correlated positively with a poorer visual outcome, p=0.002. Positivity of cultures was 34%. Gram-positive bacteria were isolated in 78.5%;Staphylococcus epidermidis(28.6%) was the most common microorganism.Conclusions: Our study emphasizes the importance of a prompt diagnosis and treatment of infectious corneal ulcers in children. Trauma and contact lenses were the main predisposing factors. Gram-positive organisms were isolated in the vast majority of cases and visual outcomes are usually poor.