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Purpose Background: Tobacco smoking during pregnancy is the first preventable cause of adverse birth outcomes such as vascular and neurodevelopment disturbation. Aims: To asses how smoking during pregnancy would affect retinal vascularization causing retinopathy of prematurity. Design: An observational cross-sectional study. Methods Records of preterm newborns (n = 293) and tobacco expossure were reviewed. Retinopathy of prematurity ( ROP) grading was evaluated in accordance with the International Classification of Retinopathy of Prematurity. Factors were evaluated using a multivariate logistic regression analysis Results Although most children did not develop ROP (74.1%), 10.9% has mild, 9.6% severe and 5.5% aggressive posterior retinopathy. Twenty percent of mothers smoked during pregnancy and 10.2% smoked ≥5 cigarettes per day. Children of smoking mothers showed higher rate of Anterior Progressive ROP (6.9%) than those who were not expossed (5.1%), and as much severe as higher number of cigarettes (10.9% vs 5.1%). However, these results were not statsically significative (p > 0.05). Conclusions A tendency to higher severity grades of ROP in connection with heavy tobacco exposure during pregnancy was observed. [ABSTRACT FROM AUTHOR]

Purpose Hereditary progressive arthro‐ophthalmopathy, also called Stickler syndrome, is an autosomal dominant genetic disease affecting connective tissue collagen. It is considered the leading cause of inherited retinal detachment in all ages and produces multisystem manifestations such as premature arthritis, micrognathia or eye disorder. Methods A 31‐year‐old man reports hereditary progressive arthro‐ophthalmopathy. He presented degenerative myopia, congenital cataract and bilateral recurrent retinal detachments during childhood. At birth, he presented craniofacial anomalies, hearing loss and flat feet. When he was 6 years old, he suffered a retinal detachment associated with giant tear, which was treated with 20G pars plana vitrectomy and injection of silicone oil. At 22 years, the right eye presented another retinal detachment that was treated with silicone band placement, cryotherapy and C3F8 gas intravitreal injection. Two months later the retinal detachment recurred in right eye, needing 23 G pars plana vitrectomy and intravitreal silicone oil implantation. Results The patient presented several ophthalmic complications such as post‐surgical ocular hypertension and retinal tears requiring selective photocoagulation with argon laser in the right eye. Recently, genetic diagnosis was confirmed by COL11A1 gene mutation. Conclusion Development, prevention and therapeutic management of ophthalmic complications during 26 years follow‐up are presented. The importance of early diagnosis and follow‐up by a vitreoretinal surgeon are also emphasized. [ABSTRACT FROM AUTHOR]

Purpose To assess the ability of optic nerve head (ONH) parameters measured with 2 different imaging technologies to discriminate between normal and glaucoma patients with visual field losses. Methods Sixty‐seven normal eyes and 43 glaucoma patients were consecutive and prospectively selected. Participants were classified depending on the results of standard automated perimetry (SAP) and intraocular pressure. All of them underwent a comprehensive ophthalmic examination, at least 2 reliable SAP tests, and imaging of the ONH with the Heidelberg Retina Tomograph 3 (HRT; Heidelberg Engineering, Heidelberg, Germany) and with Cirrus OCT (Carl Zeiss Meditec, Dublin, Ca). Only one eye per subject was randomly included in the statistical analysis. The areas under the receiver operating characteristic curve (AUCs) were plotted and sensitivity‐specificity pairs compared. Results The mean age was 55.713.6 years for the normal group and 59.16.2 years for the glaucoma group (p=0.133). The mean deviation of SAP was ‐0.71.2 dB and ‐5.96.1 dB (p<0.001) for the normal and glaucoma groups, respectively. The largest AUCs were observed for the rim area of Cirrus (0.954; 95% confidence interval [CI]: 0.919‐0.989), and the vertical cup/disk ratio of HRT3 (0.924; 95% CI: 0.890‐0.959). There was not a significant difference between them. Sensitivity at 85% fixed specificity was 86% for the rim area of Cirrus and 83.7% for the cup/disk area ratio of HRT3. Conclusion ONH parameters measured with spectral‐domain OCT and HRT3 have similar diagnostic performance. OCT, however, does not require prior manual outlining of disc boundaries, reducing the dependency on operator skill. [ABSTRACT FROM AUTHOR]

Purpose The corpus callosum (CC), with its central position in the cerebrum, has an essential role in relaying sensory, motor, and cognitive information from homologous brain regions across cerebral hemispheres. Corpus callosum agenesis (CCA) is a rare congenital malformation which is caused by an alteration in embryonic development. Methods We report the case of a 3 year old child who was diagnosed of complete corpus callosum agenesis with a normal karyotype. The neurological findings were spastic tetraparesis with dystonia, several delayed psychomotor and epilepsy. In ophthalmology examination he presented esotropia, bilateral optic nerve hypoplasia, delayed visual evoked potential flash type and altered corneal sensibility in both eyes which is manifested clinically by recurrent corneal ulcers and epithelial disruption associated with stromal edema. Results After Neurotrophic keratopathy suspected, treatment with autologous serum was decided and response to treatment was favorable in both eyes with closure of ulcers and good management of symptoms. CCA has also been described in association with other ocular abnormalities such as optic nerve hypoplasia, retinal detachments, cataracts, morning glory syndrome, iris and optic nerve colobomas, among many others. Conclusion In all patients diagnosed with agenesis of the corpus callosum, the possible alteration of corneal sensitibility is a fact that will be suspected to perform early diagnosis and appropriate treatment and follow‐up. [ABSTRACT FROM AUTHOR]

Purpose To represent and interpret the three‐dimensional geometry and distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON). Methods MS patients (n=122) and age‐matched healthy subjects (n=108) were enrolled in this observational cross‐sectional study. The Spectralis OCT system (Heidelberg Engineering) was used to determine the circumpapillary RNFL thickness in both eyes of each participant. The 768 RNFL thickness measurements provided by the Spectralis OCT were used to evaluate thickness measurements in MS patients with or without antecedent ON and to design a three‐dimensional reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes. Results RNFL thickness was decreased in MS patients, and higher in the MS group with previous ON. Statistical analysis and three‐dimensional RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area in MS eyes (101.77 µm in MS vs 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in healthy eyes vs. 149.26 previous‐ON MS eyes) in MS eyes with previous ON. Conclusion The three‐dimensional representation of RNFL thickness based on measurements provided by the Spectralis OCT allows physicians to better observe damage in the temporal areas, especially in patients with previous ON. [ABSTRACT FROM AUTHOR]

Purpose To report the clinical features and the results after an early vitrectomy of a case of a Terson syndrome following an aneurysmal subarachnoid hemorrhage Methods 32 years old male with decreased visual acuity (VA) of the right eye (RE) of evolution difficult to determine. As recent precedent a month before stands out a subarachnoid and parenchymal hemorrhage secondary to ruptured aneurysm of the right medial cerebral artery, treated by external ventricular drainage and posterior surgical clipping with satisfactory outcome. The examination revealed visual acuity of light perception in RE and funduscopy shows widespread vitreous haze with impossibility of glimpse the retina, with fibrinous‐looking condensations Results Suspecting Terson syndrome a pars plana vitrectomy is performed with aspiration of subhyaloid bleeding in the posterior pole. The patient achieved a VA of 0.9 and the funduscopy shows the demarcation zone of ancient bleeding in the posterior pole Conclusion Terson's syndrome is the combination of intraocular bleeding and subarachnoid hemorrhage secondary to rupture of an aneurysm. The bleeding can be intraretinal, subretinal or vitreal. It is a commonly underdiagnosed pathology. It is associated with worse neurological prognosis with higher rates of morbidity and mortality. However, vitreous hemorrhage is usually resolved spontaneously within a few months, and generally has good long‐term visual prognosis. But early vitrectomy is indicated in bilateral cases, persistent bleeding or proliferative vitreoretinopathy [ABSTRACT FROM AUTHOR]

Purpose To report our case report with sustained‐release dexamethasone 0.7 mg intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) in retinal vein occlusion with macular edema Methods A 81‐years old male patient with recent retinal vein occlusion with macular edema treated with sustained‐release dexamethasone 0.7 mg intravitreal implant and cataract surgery was performed. On initial examination, the right best‐corrected visual acuity (BCVA) was 0,1. Right fundoscopy revealed retinal hemorrhage in the superior quadrant of the retina. The fluorescein retinal angiography showed a delay of filling time and spectral domain optical coherence tomography (Spectralis SD‐OCT; Heidelberg Engineering, Heidelberg, Germany) showed macular edema 485 μm Results The patient was treated with two dexamethasone 0.7 mg intravitreal implant and cataract surgery in one year. During the first six months after implant the right BCVA was 0,4 and OCT: 294 μm. At six months the macular edema increased 335 μm and we treated with the second implant, the macular edema improved 280μm but not the BCVA and we realized cataract surgery and BCVA was improved to 0.5. Conclusion The dexamethasone drug delivery system is one of the most recent additions to the armamentarium against macular edema, and is intriguing for its potency, dose consistency, potential for extended duration of action, and favorable safety profile but can accelerate cataract surgery.In patients with macular edema in retinal vein occlusion, sustained‐release dexamethasone 0.7 mg intravitreal implant may be an effective treatment option to control macular edema [ABSTRACT FROM AUTHOR]

Purpose To present the case report of a patient who developed periorbital necrotizing fasciitis following trauma with favorable response. Methods 73 year‐old‐female came to the emergency department after downfall with a trauma in facial region. At the initial examination the patient had a large eyelid swelling in both eyes and a wound that required stitches on the left superciliary region. 5 days later the patient presented to our clinic with general discomfort, fever of 39°C and with slurring, crusty necrotic in the right eyelid, redness and heat in both upper eyelids and in frontal area. Results Because of clinical suspicion of periorbital necrotizing fasciitis, we performed a debridement of the wound in the right upper eyelid, draining the purulent in frontal area, sampling for culture and intravenous treatment with amoxicillin‐clavulanate. In the culture Steptococcus pyogenes isolates. After 15 days of intravenous antibiotic treatment and local cures, the patient was discharged from hospital. One month later, the patient had complete resolution of the lesions with a mild ptosis in the right eye. Conclusion Although this is a disease with a low incidence, it has a high morbidity and mortality if appropriate treatment is not performed. Treatment consists in an immediate and extensive debridement of the affected area with broad‐spectrum antibiotic. [ABSTRACT FROM AUTHOR]

Purpose To present a case report of a patient with atypical presentation of a conjunctival melanoma as an amelanotic tumor. Methods A 82‐year‐old female presenting a large amelanotic tumor in inferior tarsal conjunctiva of the right eye was referred to our hospital. Previous histological analysis diagnosed intraepithelial carcinoma. Imaging digital analysis techniques showed infiltration of the extrinsic ocular muscles but not the scleral tissue. Excisional biopsy was obtained by removing the tumor with free margins and preserving as many unaffected tissue as possible. Amniotic membrane graft was used to cover the surgical injury. Results Histopathological diagnosis confirmed amelanotic conjunctival melanoma. Systemic evaluation with imaging techniques (MRI, TC scan, Ecography...) revealed liver and kidney masses suggestive of metastasis and chemotherapy was prescribed to control the disease. Ophthalmological controls showed remission of tumor for 4 months, but new conjunctival masses appeared. At the present the patient is treated with palliative chemotherapy. Age and systemic status do not allow aggressive therapies in this patient. Conclusion Amelanotic melanoma is an atypical subtype of melanoma lacking of pigmentation. Its macroscopic aspect makes it almost impossible to clinically distinguish this tumor from less aggressive tumors, such as intraepithelial carcinomas. The diagnosis delay makes early treatment difficult in this malignant tumors. [ABSTRACT FROM AUTHOR]

Purpose To determine the capacity of the axonal application for Optical Coherence Tomography (OCT) to detect axonal loss in the retinal nerve fiber layer (RNFL) in Parkinson's disease (PD) and to evaluate the structure/function relationship between OCT measurements and visual function tests. Methods One hundred patients and 100 controls were included in the study and underwent a complete neuro‐ophthalmologic examination consisting in best corrected visual acuity (BCVA), color vision test with Ishihara's pseudoisochromatic charts, automatic perimetry with Strategy SITA standard 30.2 of Humphrey and Spectralis OCT using the new axonal application. Mean and standard deviation of all parameters were calculated and correlation between RNFL, BCVA, Ishihara test's score and the mean and mean standard deviation of the automatic perimetry. Results Significant differences between controls and patients were found in inferior and temporoinferior RNFL thicknesses (133.18 in controls vs 125.03 µm in PD, p=0.006; 149.53 vs 141.32 µm, p=0.020 respectively) and sector number 8 in papillomacular bundle (306.13 vs 271.19 µm, p= 0.006). Significant differences were also observed in automatic perimetry and Ishihara's score (p<0.001). The RNFL thickness of the papillomacular bundle showed strong correlation (correlation index >0.700) with perimetry values and mild association with Ishihara's score. Conclusion RNFL loss is detectable by the axonal application of Spectralis OCT in Parkinson disease. Functional parameters obtained by automatic perimetry present strong association with papillomacular bundle measurements. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effect of lens opacities in quality of images and reproducibility of retinal nerve fiber layer (RNFL) thickness measurements using Spectralis Optical Coherence Tomography (OCT). Methods Fifty eyes of 50 subjects (25 men and 25 women; aged from 62 to 88 years) underwent three 360° circular scans centred on the optic disc by the same experienced examiner using the "RNFL Fast" Glaucoma Application and the "RNFL‐N Fast" Axonal Application of Spectralis OCT instrument one month before and one month after cataract surgery. Comparison between the two visits and changes in reproducibility (using intra‐class correlation coefficients and coefficients of variation) were analyzed. The quality of images was also compared between both visits. Results RNFL and RNFL‐N differences were detected between both visits for average thickness, temporal and nasal quadrants (p<0.05) using Glaucoma Application and for inferior and nasal quadrants (p<0.05) with Axonal Application. RNFL average thickness was 99.6 µm in pre‐surgery visit and 102.4 µm in post‐surgery visit using Glaucoma Application; and 94.3 and 94.7 µm, respectively, with Axonal Application. Reproducibility shows better values in post‐surgery evaluation (mean coefficient of variation of 5.55% in pre‐surgery visit vs 4.32% in post‐surgery). Intra‐class correlation coefficients were higher than 0.834 in all visits and parameters, so reliability of Spectralis measurements was high with both Spectralis OCT applications. The quality of images was better in post‐surgery evaluations. Conclusion The measurements of RNFL thickness and the reproducibility of Spectralis OCT are affected by lens opacity. [ABSTRACT FROM AUTHOR]