Purpose: The purpose of the study was to evaluate the contribution of orbital biopsy for the management of patients with an orbital mass of unknown etiology using the Greenwich Grading System (GGS). Methods: This was a retrospective case series conducted at a tertiary hospital over a period of 10 years (2007–2017). Case records of all patients with an orbital mass were reviewed. All relevant data collected from the medical records electronic database were analyzed. The GGS was used to assess the contribution of orbital biopsy for the diagnosis, investigation, and treatment of each patient. Results: Ninety-two medical records were reviewed; 34 patients underwent orbital biopsy. The mean age was 53 ± 26 years and 58.7% were female. In the biopsied group, the most common histopathological diagnoses were lymphoma (44.1%), nonspecific orbital inflammation (14.4%), and squamous cell carcinoma (8.8%). After the biopsy, a new diagnosis was obtained in 41.2%, although in most patients (58.8%), the biopsy confirmed the suspected diagnosis. Regarding the therapeutic management, 32.4% started a new treatment, 29.4% did not change their treatment, 32.4% altered/stopped their treatment, and 5.9% allowed reassurance and explanation for the patients. Conclusions: Orbital biopsy was considered a valuable investigation for the management of patients with an orbital mass of unknown etiology. In most cases (58.8%), the result of the biopsy confirmed the suspected diagnosis, and in around 41.2%, a new diagnosis was made. Most of the patients (64.8%) changed their treatment or started a new one based on the histopathological result.

Purpose: The purpose of this study is to present a novel method of capturing and viewing stereoscopic ophthalmological pictures using the inexpensive smartphone technology applied to a common slit lamp. To assess the best perceived method for viewing this images when reconstructed. Methods: We adapted two smartphones using a fixation device for each slit-lamp ocular. By obtaining simultaneous images of each ocular, we reconstructed them in different formats. Images from a trabeculectomy bullae, corneal transplant, and glaucomatous optic nerve (GON) were rated by five independent ophthalmologists in terms of perceived image quality from 1 to 5. Results: All of the images obtained were three dimensional and of very good quality (grading 4.04 ± 0.84) in a scale from 1 to 5. Parallel-eyed images were graded with a mean of 4.5 ± 0.5, and anaglyph images were graded 3.58 ± 0.86, which was statistically lower than for parallel-eyed format (P = 0.002). Mean image quality was lower for the optic nerve and higher for the penetrating keratoplasty (PK) image, but grades did not differ significantly for the three different pictures (bullae vs. PK P = 0.18; PK vs. GON P = 0.07; bullae vs. GON P = 0.59). Conclusions: It is possible to obtain the quality stereoscopic images by combining the smartphone technology and fixation devices.

Purpose: The purpose is to identify the various causes of ocular disease and surgical interventions undertaken in children (0–18 years of age) seen during an annual ophthalmic surgical trip to Belize. Methods: A retrospective, cross-sectional review of records from seven annual surgical trips conducted by the World Pediatric Project providing pediatric ophthalmologic clinical and surgical care to Belize from 2013 to 2019 was performed. Results: The charts of 313 patients who received care during the surgical mission trips were examined. From these 313 patients, there were 545 independent clinical encounters, yielding 405 diagnoses. Patients aged 6–10 years were most commonly seen (32.1%) followed by those 2–5 years old (28.1%). The most common pathophysiology seen was strabismus/ocular motility disorder (151 diagnoses; 37.4%), followed by refractive issues (69 diagnoses; 17.1%), eyelids and/or lacrimal system disorders (53 diagnoses; 13.1%), disorders of the retina/vitreous (30 diagnoses; 7.4%), lens abnormalities/cataract (28 diagnoses; 6.9%), amblyopia (23 diagnoses; 5.7%), disorders of the cornea/conjunctiva (23 diagnoses; 5.7%), trauma (13 cases; 3.2%), conditions affecting the globe/orbit (7 diagnoses; 1.7%), other (6 diagnoses; 1.5%), and glaucoma (1 diagnoses, 0.2%). Conclusion: This study identified the most frequently diagnosed ocular conditions encountered during annual surgical mission trips to Belize. The most prevalent pathophysiology encountered was strabismus/ocular motility disorders, followed by refractive issues. The most common refractive issues encountered were myopia and astigmatism. This is the first study detailing pediatric ocular disease in Belize.

Background: Medical ministry international (MMI) is a Canadian charitable organization that coordinates healthcare missions to underserved people in developing countries. Objective: We report on the baseline clinical findings of a mission trip to Ciénaga de Oro, Colombia, present the methods used in the mission and the efforts to establish a local eye care service with long-term sustainability. Methods: Data were collected on patients seen during a 2-week mission trip from January 13 to 24, 2020. Data included eye health and the services given. Results: Altogether 5529 patients were seen by the team. Nearly 247 surgeries were performed by ophthalmologists. The most common diagnosis performed was a refractive error, for which 4066 patients (74%) received eyeglasses. Another 835 (15%) had a consultation by an ophthalmologist, of which 260 (5%) received surgery, mostly manual small incision cataract surgery and intraocular lens insertion. Conclusions and Importance: MMI is helping to reduce the prevalence of preventable blindness in the Ciénaga de Oro population; however, further training to increase the capacity of local ophthalmic services is required to improve long-term eye care to the community.

Introduction: The purpose of this study was to examine the relationship between diabetes and glaucoma. Methods: Consecutive 143 subjects with primary angle-closure glaucoma and 127 subjects with primary open-angle glaucoma (control) were studied retrospectively at an urban Veterans Administration Hospital. In addition to ocular examination findings, body mass index (BMI) and diabetes mellitus (DM) status were recorded. Results: All subjects in this study were male. The mean age was 72.3 years old in primary open angle versus 71.1 in primary angle-closure subjects. Half of the subjects with angle closure and 70% of open-angle subjects were self-identified as African–American. BMI was not significantly different between the two groups (28.2 in open angle vs. 28.7 in angle closure; P = 0.45). The percentage of DM was higher in subjects with primary angle closure than in those with primary open-angle glaucoma (43% vs. 29%, P = 0.001; Chi-square test). The odds of having DM were nearly two times higher in angle-closure subjects than open-angle subjects (Logistic regression, P = 0.01, 95% confidence interval: 1.17–3.30). Conclusion: In this retrospective study, diabetes was found to be associated with higher risk for primary angle-closure glaucoma.

Purpose: The aim of this study is to compare the reduction percent of intraocular pressure (IOP) after selective laser trabeculoplasty (SLT) or pattern laser scanning trabeculoplasty (PSLT) in a group of patients with hypertensive glaucoma. Materials and Methods: A quasi-experimental prospective study of the patients with baseline IOP of 20 mmHg or more (with at least 1 IOP lowering medication) underwent either PSLT or SLT at 360°. IOP was measured in the following time points: Hour 1, Day 1 and 7, months 1, 3, 6, and 12 after the laser procedure. Results: The mean age was 68.1 ± 10.1 in the PSLT group and 71.8 ± 4.0 in the SLT group. Eleven eyes (8 patients) underwent PSLT and 9 eyes (6 patients) underwent SLT. Baseline IOP was 22.45 ± 2.4 mmHg, PSLT; 25.0 ± 2.2 mmHg, SLT; (P > 0.05) on an average of 2.4 medications. In the PSLT group, the mean IOP at 1 h, 1, 3, 6 and 12 months was 19.0 ± 5.0, 14.7 ± 2.4, 15.3 ± 3.0, 14.5 ± 2.7, and 13.0 ± 3.1, respectively. In the SLT group, the mean IOP at 1 h, 1, 3, 6 and 12 months was 25.6 ± 6.4, 15.9 ± 4.4, 15.3 ± 2.6, 16.7 ± 4.8, and 21.2 ± 4.3, respectively. IOP was significantly lower in the PSLT group compared to the SLT group at 1 h (P < 0.01) and 12 months (P < 0.01). No serious adverse events were recorded. Conclusions: PSLT was similar in effect compared to SLT at 1, 3, 6 months, and more effective than SLT at 12 months.

Background: Uveal melanoma (UM) is the most common primary intraocular tumor in adults. Despite successful local treatment, approximately 50% of these patients develop lethal metastatic disease. BRCA1-associated protein 1 (BAP1) encodes BAP1, which functions as a tumor suppressor. Inactivation by a somatic mutation in BAP1 results in a loss of protein expression, which is associated with increased risk of metastasis. Aim: To analyze the expression of BAP1 protein in primary uveal tumors and their corresponding metastasis in an animal model of UM and to determine whether BAP1 expression is lost during the metastatic process. Subjects and Methods: Postmortem eyes and lungs with metastasis from nine rabbits previously inoculated with human UM cells expressing BAP1 (92.1 strain) were analyzed. Immunohistochemistry was performed on formalin-fixed paraffin-embedded samples using a monoclonal BAP1 (C-4) antibody. Expression was evaluated by the extent and intensity of staining. All primary tumors and metastasis were positive for BAP1. Results: The staining was diffuse and intense in the primary tumors of four rabbits (67%), focal-intense in one rabbit and focal-mild in one rabbit. All lung metastasis showed focal staining. All animals with intense BAP1 staining in the primary tumor showed mild BAP1 in the metastasis. Discussion: A predominant pattern observed between primary and metastatic lesion shows a transition from moderate into mild intensity and diffuse into the focal extent, suggesting a decrease in BAP1 expression. Future studies, including the human tissue of primary UM and their corresponding metastasis, should be performed to corroborate these findings.

Background: More than 50% of patients undergoing cataract surgery have corneal astigmatism ≥ 0.75 diopters (D). A fundamental factor for the calculation of the intraocular lens (IOL) is the power of corneal refraction, which can be calculated with different methods and incorporated into different mathematical prediction models. Little information has been written comparing new formulas that take into account posterior keratometry. Aims and Objectives: Compare the prediction of the ideal IOL with different formulas that use anterior keratometry and posterior keratometry measured by different devices. Setting: Private practice, Guadalajara, Jalisco, Mexico. Materials and Methods: A descriptive, observational and retrospective study was carried out where 50 healthy eyes with cataract and a degree of corneal astigmatism >1 D were evaluated, IOL calculation was compared using the anterior and total keratometries measured with the Zeiss IOL master 700 and the total corneal refractive power (TCRP) keratometries of the Oculus Pentacam. The results were also compared with the Haigis Suite, Barrett TK and Z Calc formulas. The IOL used for the analysis was the Zeiss AT TORBI 709M/MP. Results: It was found that the different formulas can generate different predictions in the cylinder power but no significant differences in the sphere power. Measurement of the posterior cornea did not significantly change the selection of the ideal IOL for implantation. Calculations with Haigis Suite and Z Calc are very similar. Barrett TK-Toric uses less cylindrical power than Haigis Suite and Z calc, regardless of the method chosen to measure corneal power. Conclusion: Our results contribute to clarify the current scenario where the great variety of options for the calculation of IOL generates uncertainty about which method generates better results of postoperative refraction.

Purpose: The purpose was to describe the changes in the visual function of patients with cataract, optic neuritis, amblyopia, and retinopathies evaluated at the Hospital de San José, Bogotá, Colombia, between August 2015 and May 2019. Materials and Methods: This is a descriptive cross-sectional study. One hundred and ninety-six patients with a diagnosis of cataract, retinopathies, optic neuritis, and amblyopia were evaluated; the tests were performed to determine the visual function (visual acuity, stereopsis, contrast sensitivity, and color tests). Qualitative and quantitative characteristics were described. Results: Of the 196 patients, 17.3% had amblyopia of any cause, 16.8% optic neuritis, 40.8% cataract, and 25% retinopathies of multiple etiologies. Amblyopic patients presented less deterioration of the stereopsis (160 arc seconds), whereas patients with retinopathy presented more significant compromise (400 arc seconds). Patients with optic neuritis showed severe deterioration in contrast sensitivity; in the other pathologies, the decline was moderate. Nearly 42.4% of the patients with optic neuritis and 38% of the amblyopic patients did not present color vision disorders, whereas 32.6% and 31.2% of the patients with retinopathy and cataract showed tritanomaly. Conclusion: Visual acuity is not equivalent to visual function. Stereopsis, contrast sensitivity, and color vision are affected by pathologies such as amblyopia, optic neuritis, cataract, and retinopathies. These assumptions of visual function could be considered for studies that take into account all the factors that may compromise the visual performance and, accordingly, define early diagnosis strategies, in addition to therapeutic behaviors such as performing early cataract surgery and visual rehabilitation.

Introduction: It is unusual to have uveal and cutaneous melanoma in the same patient. It is challenging to differentiate between primary uveal melanoma (UM) and melanoma metastatic to the uvea. Objective: The aim of this study is to evaluate the characteristics of patients who presented with concurrent melanomas (primary or metastatic) of the skin and uveal tract. Materials and Methods: Eleven patients with both uveal and cutaneous melanomas were obtained from the McGill University Ocular Pathology Laboratory database. The characteristics included cell type, number of mitotic figures, presence of necrosis, the time interval between primary and secondary melanoma and the presence of metastasis in other organs. Results: Five patients presented with both primary uveal and primary cutaneous melanoma, three patients with UM metastatic to the skin, and three patients with cutaneous melanoma metastatic to the uvea. In all of our cases, there was a time difference between the appearance of cutaneous and UM in the same patient. Conclusion: Patients with two primary melanomas presented with spindle-cell type (uveal tumor), a Breslow index <1 mm, >7 years between tumors. Systemic disease was negative. Patients with metastasis from cutaneous melanoma to the eye and from ocular to the skin showed epithelioid cell type, a Breslow index >1.5 mm, <5 years between tumors and positive systemic disease.

Background: Phacoemulsification is the main stay of cataract extraction surgery in the developed world as well as it is becoming increasingly popular in the developing nations as well. However, this technique is not widely incorporated in the residency training program in many developing nations. Objective: This study was conducted to evaluate the visual outcomes and complications of phacoemulsification surgery performed by a trainee surgeon. Methods: A prospective, cross-sectional study was performed in the tertiary eye hospital of eastern Nepal. All the consecutive cases of phacoemulsification surgery were included which was performed by a trainee surgeon with previous exposure of conventional extra-capsular cataract surgery and competency in sutureless manual small incision cataract surgery. The technique implied for nuclear division was stop and chop method. The visual outcomes and the complications of the surgery were evaluated. Results: A total of 200 eyes of 200 patients were included. The patients were followed up for 12 weeks. The mean age of the patients was 57.8 ± 9.8 years. The average effective phacoemulsification time (EPT) was 21.6 ± 15.8 seconds. The incidence of intra-operative complication of posterior capsular rupture with vitreous loss was 6/200 (3%). Striate keratopathy was present in (6.5%) of the cases in the first post-operative day. At the final examination, improvement in vision by 6/12 or better was observed in 183 (91.5%) eyes. Conclusion: Improvement in surgical teachings, good orientation to manual cataract extraction, careful selection of early cases and staffed supervision will lead to safe and easy transition to phacoemulsification surgery.

Background: Recent advances in ophthalmic evaluation technology allow the measurement and quantification of high-order optical aberrations (HOAs). Several professionals have superior visual function compared to the general population. Objective: This study is to characterize the profile of HOAs in the elite police of the São Paulo military police. Material and Methods: This is an observational clinical study of a case series with 42 eyes of 21 patients. The objective was to compare HOAs between snipers and civilians, through assessments of visual acuity and ocular aberrometry. The patients were divided into two groups: elite and control according to their profession. The elite group had more eyes with visual acuity better than or equal to 20/15. Results: The elite group had slightly lower values of higher order aberrations: 0.26 and 0.29 in the elite group and 0.30 and 0.31 in the control group. It was possible to verify that visual acuity both with and without correction was better in patients in the Elite group, even though high-order aberrations did not present significant differences in the mean. Conclusion: It was possible to verify that visual acuity both with and without correction was better in patients in the Elite group, even though high-order aberrations did not present significant differences in the mean values.

Purpose: The aim of this study was to evaluate the long-term efficacy of intraocular pressure (IOP) control and complications of pars plana Ahmed glaucoma valve (AGV) implantation in refractory glaucoma patients. Design: This was a prospective interventional study. Materials and Methods: We conducted a single-center study, involving eyes with refractory glaucoma. Study variables were IOP, the number of glaucoma medications, and corrected distance visual acuity (CDVA) evaluated preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and every 6 months till the last follow-up. Complete success was defined as absolute if IOP was between 6 and 21 mmHg in the absence of any glaucoma medication and qualified success if IOP was between 6 and 21 mmHg with medication at the last follow-up. Results: The study included 27 patients (29 eyes) with a mean age of 54.28 (standard deviation [SD]: 16.76; range: 11–73) years and a mean follow-up of 21.31 (SD: 20.38; range: 6–60) months. The mean IOP reduced from 38.14 (SD: 7.4; range: 25–50) mmHg preoperatively to 12.76 (SD: 3.92; range: 6–20) mmHg at the last follow-up (P <0.001). CDVA improved in 16 (55.2%) eyes, remained the same in 10 (34.5%) eyes, and worsened in 3 (10.3%) eyes. There was a mean reduction of antiglaucoma medications from 4.07 (SD: 0.26) preoperatively to 0.93 (SD: 1.31) postoperatively (P <0.001). The absolute success rate was 62%, reaching 100% in terms of qualified success. Postoperative complications included vitreous hemorrhage in 4 (13.8%) eyes, transient hypotony in 3 (10.3%) eyes, hyphema in 2 (6.9%) eyes, tube exposure in 2 (6.9%) eyes, and development of a small iris cyst in 1 (3.4%) eye. Conclusion: Pars plana implantation of AGV is a viable option in refractory glaucoma eyes where other surgical options are precluded, as it provides a good success rate with fewer postoperative complications. One must still keep a watch for tube exposure, vitreous incarceration in the tube, vitreous hemorrhage, and future retinal complications.

Context: Most ophthalmologic literature is written in English. There is a wide range of books available for the preparation of the International Council of Ophthalmology (ICO) examinations. Aims: The aim of this study is to evaluate the assessment of the literature consulted by Spanish-speaking candidates who sat for the ICO examinations. Settings and Design: Observational study based on a survey to candidates in Spanish-speaking countries. Methods: Online surveys were sent to candidates residing in Latin America and Spain who passed the ICO examinations in the past 5 years. The survey asked about fluency in English, language in which the examination was studied, literature consulted in English and Spanish. Literature was classified by the language. Statistical Analysis Used: Qualitative analysis and description of the answers. Results: One hundred and thirty-three responses were obtained from the candidates from Argentina, Chile, Colombia, Costa Rica, Ecuador, Spain, Mexico, Peru, the Dominican Republic and Venezuela, who had passed at least one ICO examination. Seventy-eight resources were identified (14 in Spanish and 64 in English). The most widely used resource was the Basic and Clinical Science Course collection of the American Academy of Ophthalmology, English version. Conclusions: The prevalence of English bibliography can be a challenge for Spanish-speaking candidates when taking international examinations. It would be useful to increase the number of publications and more updated literature in Spanish to encourage Hispanic candidates.

The purpose is to report the ocular complications observed after compound cranial nerve palsies secondary to multiple clivus chordoma resection surgeries. A 38-year-old man was referred to our clinic with diplopia and foreign-body sensation. Examination revealed a right peripheral facial paralysis with paralytic lagophthalmos leading to exposure keratopathy and a right sixth nerve palsy with esotropia. Subsequently, the patient developed a longitudinal fusiform-shaped corneal epithelial defect in the right eye. The corneal sensation was reduced due to a fifth nerve palsy leading to neurotrophic keratopathy. The combination of neurotrophic with exposure keratopathy is one of the worst scenarios for corneal integrity.

Objective: To find out whether there exists a correlation between the quantum of energy used and the amount of rise of intraocular pressure (IOP) following neodymium: yttrium aluminum garnet (Nd: YAG) laser capsulotomy. Materials and Methods: A total of 110 patients who had undergone Nd: YAG laser posterior capsulotomy for the management of posterior capsule opacification with a minimum of 3 months following cataract surgery were enrolled after taking written informed consent. After detailed history and ocular examination, Nd: YAG laser capsulotomy was performed. Prelaser IOP was noted. Nd: YAG laser posterior capsulotomy was performed. Laser energy used was noted following which postlaser IOP was also recorded after 1, 2, and 4 h postprocedure. Paired t-test was used for the comparison of means of IOP and energy levels. Receiver operating characteristic analysis was used to predict the cut-off value of energy on the basis of change of IOP from baseline. Results: The mean energy used in the Nd: YAG laser posterior capsulotomy procedure for all patients was 58.57 ± 34.63 mJ. The mean IOP at 1^st h follow-up was 15.32 ± 2.91 mmHg, at 2^nd h follow-up was 16.24 ± 3.23 mmHg, and at 4^th h follow-up was 16.18 ± 3.35 mmHg. At all three follow-ups, the mean change in IOP was found to be statistically significant (P < 0.001). Conclusion: Postlaser IOP rise is minimal and transient; it varies with the amount of energy used.

Background: Etiologically ocular injuries can be classified into domestic, occupational, sports, road traffic accidents, iatrogenic, fights and assaults, and war injuries. In the 1960s and 1970s, road traffic accidents became the most common cause of serious ocular injuries. In the 1980s, sports and leisure activities became a common cause of severe eye injury. The home is now the most common location for eye injuries. However, bomb blast and battlefield ocular injuries are becoming increasingly common in different parts of the world. Recently introduced non-lethal pellet guns used by law enforcement Indian agencies in Kashmir were the most common cause of ocular injuries in the valley. Objective: The objective of this study was to evaluate ocular pellet gun injuries in patients of a conflict zone by a so called non-lethal weapon as a mass control measure. Method: The study was conducted in post graduate department of Radiodiagnosis and imaging, Government Medical College, Srinagar Jammu and Kashmir. Our study was conducted between January 2019 to 15th May 2019. A total of 30 patients with ocular pellet injuries were taken up for study. Results: The most common type of injuries encountered were corneal laceration in 66.7 % eyes, vitreous haemorrhage in 52.8% and scleral laceration in 33.3% of eyes. Indirect signs like decreased volume of anterior chamber were suggestive of corneal laceration. Retained intraocular foreign body (IOFB) was seen in 7 patients and intraorbital foreign body excluding intraocular foreign body in 3 patients. Conclusion: In conclusion a so called non-lethal pellet gun used by law enforcement agencies has the potential to cause devastating ocular injuries.

Purpose: The purpose of the study was to evaluate the quality of life and visual results after yttrium aluminum garnet (YAG) vitreolysis in symptomatic vitreous floaters. Methods: This was a prospective case series study including patients with symptomatic floaters attending the Oftalmosalud Institute of eyes and underwent YAG laser vitreolysis. All patients completed the National Eye Institute Visual Functioning Questionnaire 25 for the quality of life assessment and the presence of floaters as well as the measure of the visual acuity reported preprocedure and after 3-month follow-up. Statistical analysis was done using score 0–100 for each question, and a sign test for paired samples was used. Results: Twenty eyes of 20 patients were evaluated. The comparisons for the questionnaire show an improvement in the general vision (P = 0.008), near vision (P = 0.001), and distance vision (P = 0.012). Furthermore, the dependency of glasses (P = 0.012), the score of mental health (P = 0.007), and the best visual acuity (P = 0.004) were improved. Patients who referred improvement in the quality of life were 75% pseudophakic patients and 25% phakic patients. The complications were high intraocular pressure and subcapsular cataract. Conclusions: Our study revealed a moderate improvement in floater symptoms and in quality of life and visual outcomes.