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Purpose: The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake. Methods: A cohort of 100 participants, including 50 individuals with ADHD and 50 age‐ and sex‐matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non‐cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings. Results: We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non‐cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049). Conclusions: Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To compare the intraocular pressure after two surgical techniques: combined non‐penetrating deep sclerectomy with phacoemulsification (Phaco‐NPDS) and non‐penetrating deep sclerectomy (NPDS) alone. Methods: It is a retrospective study including thirty‐two patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) who were not controlled with medication. They were assigned to Phaco‐NPDS (twenty‐two eyes) or NPDS (twenty eyes). Complications in surgery were noted and also, they were followed up after the surgery and intraocular pressure (IOP) was measured at one day, a month, six months and a year after the surgery. Moreover, best corrected visual acuity (BCVA) and the number of the anti‐glaucoma medications at the end of the postoperative medication was measured. Results: Mean IOP in the Phaco‐NPDS group decreased from 24.55 ± 5.8 mmHg to 17.31 ± 2.1 mmHg and in the NPDS group from 26.05 ± 4.1 to 15.6 ± 2.3 mmHg one day after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p < 0.05). There was no significant IOP difference between Phaco‐NPDS and NPDS patients postoperatively (p > 0.05). The mean number of glaucoma medications decreased from 3.31 ± 1.4 to 0.68 ± 0.2 and from 3.2 ± 1.3 to 0.3 ± 0.5 in the Phaco‐NPDS and NPDS groups, respectively. The decreases in the mean number of the anti‐glaucoma medications at the end of the postoperative, 24‐month follow‐up period were found to be statistically significant for both Phaco‐NPDS and NPDS groups (p < 0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco‐NPDS group (p < 0.05). Conclusions: Phaco‐NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco‐NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To compare different macular, peripapillary and papillary parameters between attention deficit hyperactivity disorder (ADHD) and normotypical subjects. Methods: In this observational, prospective, case–control study a group of 50 subjects with ADHD were compared with a group of 50 normotypical subjects (controls). Both groups underwent a complete ophthalmological study and optical coherence tomography (OCT) measurements including thickness of the entire retina, inner and outer layers thickness at the macula using 1–3‐6 mm Early Treatment Diabetic Retinopathy Study (ETDRS) grid, peripapillary nerve fibre layer (pRFNL) thickness and Bruch's membrane opening‐minimum rim width (BMO‐MRW) parameters. Both eyes, the right and the left one, were compared independently between both groups. Results: When analysing the macula, it was seen a diffuse thinning of complete retina, inner retina and outer retina presenting symmetrical thinning patterns in both eyes in ADHD. The thickness of all pRNFL sectors were also significantly reduced in both eyes in ADHD in all the quadrants. However, BMO‐MRW parameters did not show any differences in any eye between both groups. Conclusions: Attention deficit hyperactivity disorder is associated with a diffuse thinning of the entire retina, inner retina and outer retina, furthermore pRNFL was also significantly reduced in both eyes. [ABSTRACT FROM AUTHOR]

Aims/Purpose: A minimally invasive surgical technique in glaucoma surgery is XEN implant. It allows direct evacuation of aqueous humour from anterior chamber to subconjunctival space. It is indicated in mild or moderate primary open angle glaucoma in patients with treatment with 2 or more active ingredients and good conjunctival status. The objective is to evaluate the effectiveness and safety of XEN implant isolated versus combined cataract surgery. Methods: Single‐centre retrospective observational study, conducted between 2018 and 2023. Follow‐up of 1 year in a sample of 44 eyes operated with XEN implant, 15 with isolated implant and 29 combined surgeries with cataract. Quantitative variables are expressed as mean ± standard deviation. Comparison between variables was performed using Student's t‐test after testing for normality of distribution using the Shapiro–wilk test. Results: Combined cataract surgery with respect to XEN implant placement showed no significant difference in visual acuity improvement, nor in the decrease in post‐surgical hypotensive treatment and intraocular pressure, except in the first month in favour of isolated surgery (p > 0.02). Follow‐up with visual field and optical coherence tomography showed no significant differences, suggesting that there was no progression of glaucoma with both techniques. There were no intraoperative complications. Needling manoeuvre was performed in 60% of patients with isolated XEN compared to 30% with combined surgery. Good safety profile. Other studies find no significant differences in the postoperative success rate between combined surgery or not with phacoemulsification, nor differences in outcomes in phakic versus pseudophakic patients. Conclusions: The XEN implant is effective and safe in terms of IOP lowering and the number of hypotensive drops. There are no significant differences in IOP lowering or in the number of drugs to be administered between the XEN implant alone and combined cataract surgery. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To compare the vascular density of macular superficial and deep vascular complexes between dyslexic subjects and normoreaders at the fovea and parafovea. Methods: We performed a pilot study examining 60 eyes—36 of subjects with dyslexia and 24 of normoreaders as controls. Al the participants underwent an ophthalmological examination complemented with an optical coherence tomography angiography (OCTA) (Spectralis, Heidelberg Engineering, Germany), in which we measured the vascular density of the deep and superficial vascular complexes of the macula using an ETDRS123 pattern. Results: The deep vascular complex of the fovea was found to have a significant increase in the density of the different subfields of the inner and outer parafovea in the dyslexic group, as compared to the normoreaders. In contrast, no differences were found for the superficial vascular complex at any subfield. Conclusions: The increase in the deep vascular complex density of the macula could be associated with dyslexia. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Systemic sclerosis, also known as scleroderma, is a rare autoimmune disease that involves the hardening of the skin and also hinders the blood supply by occluding the small arteries and capillaries that carry blood to the tissues. Our aim was to compare the retinal thickness of different segmentations at the macula. Methods: In this pilot study 22 eyes from subjects with systemic sclerosis were compared with 22 eyes from healthy subjects (controls). All participants underwent a complete ophthalmological study and optical coherence tomography (OCT) measurements (Spectralis, Heidelberg Engineering, Germany) including complete retina, inner and outer layers, intermediate retinal layers (inner nuclear layer + outer plexiform layer + outer nuclear layer) and ganglion cell complex thickness (macular retinal nerve fibre layer + ganglion cell layer + inner plexiform layer) at the macula using Early Treatment Diabetic Retinopathy Study (ETDRS) grid so foveal, parafoveal and perifoveal subfields were measured. The values of the thickness of each segmentation in relation to the thickness of the complete retina (considered layer segmentation thickness divided by complete retina thickness) were also compared. Results: Best‐corrected visual acuity was lower in systemic sclerosis group but age, gender, spherical equivalent, intraocular pressure and axial length did not show any differences between both groups. Diffuse thinning in parafovea of complete retina, inner retina, outer retina, intermediate retina and ganglion cell complex was found in systemic sclerosis group. Fovea is also thinner in complete retina and intermediate retina in systemic sclerosis group. When considering the comparisons of the results in relation to complete retina thickness no differences were found between groups. Conclusions: Systemic sclerosis induces the thinning specially in the parafovea of all the considered macular segmentations alike. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Coats' disease is an idiopathic ocular condition characterized by retinal telangiectasia, aneurysms, and exudation, frequently affects unilateral eyes of young males. Rare pathology of difficult diagnosis and clinical management. Follow‐up by multimodal imaging of clinical improvement after correct treatment in Coats' Disease. Methods: Morales Meseguer University Hospital, Murcia, Spain. Observational study using multimodal imaging of clinical cases in patients diagnosed with Coats' disease. Retrospective follow‐up during several visits between 2021–2023. Images taken with optical coherence tomography (OCT), fluorescein angiography (FA) and autofluorescence. Results: Presentation two clinical cases. A 56‐year‐old female and a 28‐year‐old male diagnosed with Coats disease in right eye. Best corrected visual acuity (BVAC) of 0.6 and 0.5, respectively. Female had macular oedema (ME) with hard exudates in temporal arcade territory with areas of venous and arterial sheathing, macroaneurysm in inferior temporal arcade territory. Hypertrophy of the peripheral retinal pigment epithelium. OCT shows EM, subretinal fluid (SRF) and hyperreflective dots in middle layers. Male with a history of vitrectomy and phacoemulsification after regmatogenous and tractional retinal detachment secondary to the disease, presents pseudophakia, angular synechiae and iridotomies, vascular malformations, inferior haemorrhages, zone of temporal and nasal inferior exudation with FSR area, inferior tear pigmented with laser. OCT shows ME with FSR. Both cases, FA proves blood fluids levels and saccular aneurysms of arterial arterioles and venules. We note an improvement BVAC and EM with resolution of FSR on multimodal imaging study after intravitreal and focal laser treatment. Conclusions: Multimodal imaging in the follow‐up of Coats' disease is essential to assess correct treatment. Treatment with focal laser and intravitreal therapy is safe and effective in control of Coats disease. [ABSTRACT FROM AUTHOR]

Purpose: This is a retrospective longitudinal observational study to detect amblyopia and other visual anomalies (refraction, strabismus, pathologies...) in 3, 4 and 5‐year‐old schoolchildren. Amblyopia is a disorder of sight in which the brain fails to fully process input from one eye and over time favours the other eye. It results in decreased vision in an eye that typically appears normal in other respects. Early detection improves treatment success. There is currently an early detection program but according to a recently published study, does not have good compliance or appropriate material. Methods: The study was carried out with children aged 4–6 years from 4 different schools, collecting 491 children with the corresponding informed consent of their parents. The study was divided into two phases, first an optometrist performed an external examination, red reflex, pupillary examination, ocular motility, cover test and photoscreening with a portable autorefractometer. And if any anomaly is detected in the second phase, it would be explored by an ophthalmologist who would also perform stereopsis tests, visual acuity, dilated refraction, eye fundus, and diagnosis and treatment. Results: 491 children were included in this study, visual anomalies were detected in 96, of which 60 were studied in our center. It was detected 47% who had refractive problems, 5% strabismus and 0% opacities. Extrapolating it to the total number of patients seen, 9% had refractive problems and 1% strabismus. Conclusions: Amblyopia has a prevalence of 6% in the population. Its treatment is relatively simple with glasses and patches at a low cost. There is a prevalence of 5%–7.5% of amblyopia in <6 years, 1%–3% strabismus in <6 years as well as 1 of 3 school failure is caused by visual problem. Paediatric check‐up or other check‐ups that these schoolchildren do not detect this type of condition. Therefore, the Campaign for the Prevention of Amblyopia and Other Visual Anomalies idea should be implemented in all the Autonomous Communities. Reference 1. Eileen E Birch. Amblyopia and binocular vision. Prog Retin Eye Res. 2013; 33: 67–84. [ABSTRACT FROM AUTHOR]

Purpose: Drugs mostly sulfa‐related compounds, have produced uveal effusions, forward rotation of the iris‐lens diaphragm, transient myopia, and secondary angle closure. It has been recently encountered one case in which uveal effusions have occurred after administration of topiramate, a new anticonvulsant medication. Methods: A 54‐year‐old woman was seen in our emergency department with severe headaches, progressively blurry vision and photophobia in both eyes starting that morning. On examination, her visual acuity was hand movement in both eyes. Central corneal edema was observed, narrow chamber and anterior lens‐iris complex displacement with an unreactive middle pupil in both eyes. The funduscopic examination was difficult to assess due to the media opacity. Intraocular pressure measured with an applanation tonometer was 45 mm of mercury (mmHg) in the right eye and 50 mmHg in the left eye. Her medications included topiramate which she had started 2 weeks prior to initial examination due to headaches followed by neurology. Results: Topiramate‐induced angle closure has even been described as an idiosyncratic reaction in patients with normal depth of anterior chamber. The drug causes a prostaglandins increasement that trigger ciliary body edema at the local level but without acting at the systemic level. Ultrasound biomicroscopy shows the presence of a ciliochoroidal effusion syndrome, edema and the ciliary body anterolateral rotation, with zonular relaxation, changes that lead to iris‐lens diaphragm anterior displacement and, as a consequence, narrowing of the responsible anterior chamber with an acute glaucoma crisis. Conclusions: Topiramate is a sulfamate monosaccharide and belongs to a new generation of antiepileptic drugs, widely prescribed throughout the world as treatment of generalized tonic–clonic seizures and partial seizures. Prophylaxis of migraine, bipolar disorder, depression and neuropathic pain are other recent indications of its use. Bilateral acute glaucoma due to uveal effusion syndrome should be considered as an infrequent complication of topiramate use. References. 1. Prithvi S. Sankar, MD; Louis R. Pasquale et al. Uveal Effusion and Secondary Angle‐Closure Glaucoma Associated With Topiramate Use. Arch Ophthalmol. 2001;119(8):1210–1211. [ABSTRACT FROM AUTHOR]

Purpose: To assess the importance of treating the patient with choroidal osteoma‐associated neovascular membrane by administering anti‐angiogenic (anti‐VEGF) drugs. Methods:: We present a descriptive study (case report). We have performed a multimodal imaging study of a patient with an inferior temporal peripapillary choroidal osteoma. The best corrected visual acuity (BCVA) was taken in a patient diagnosed with a choroidal osteoma after magnetic resonance imaging (MRI) and ultrasound. The patient presented with a decrease in visual acuity and a study using optical coherence tomography angiography (OCTA) revealed a type II neovascular membrane affecting the temporal area of the choroidal osteoma. Optical coherence tomography (OCT) revealed a neurosensory detachment. Results: Serial OCT evaluation revealed a neovascular membrane with associated neurosensory detachment, which was treated with intravitreal injections of Aflibercept, resulting in an MAVC of 0.1 to an MAVC of 0.7 after 2 months. On OCTA we observed disruption of the retinal pigment epithelium. Treatment with monthly injections is required for the first 3 months, with bimonthly treatment for a further 6 months. At present the MAVC is 0.6 and no further injections are required for the time being. Conclusions: Serial multimodality imaging is very useful in the follow‐up of patients with choroidal tumours. It allows us to observe associated complications such as the neovascular membrane that we found in the context of a patient with a choroidal osteoma, a benign bone tumour that mainly affects young women without associated diseases. Despite being benign, it can cause irreversible loss of vision either due to the tumour affecting the macular area or due to complications such as choroidal neovascularisation, which occurs in one third of cases. [ABSTRACT FROM AUTHOR]

Purpose: To asses the importance of multimodality imaging in successive examinations of patients with retinal branch vein occlusion in order to evaluate possible unexpected complications. Methods: We present a descriptive study (case report). We have performed a multimodal imaging study of a patient with an inferior temporal branch vein thrombosis. The best corrected visual acuity (BCVA) is taken in a patient who received 5 intravitreal injections of Ranibizumab. Posteriorly the patient presented with a decrease in visual acuity and the angiographic study showed a venous vasculitis involving the inferior temporal branch retinal vein, resembling frosted branch angiitis. Optical coherence tomography (OCT) showed inflammatory cystic macular edema with neurosensory detachment. To perform angiography and OCT, we use the Heidelberg Spectralis. Results: Serial evaluation with OCT allowed the observation of a cystic macular edema with neurosensory detachment that was treated with intravitreal Dexamethasone implantation achieving a BCVA of 0.3 to a BCVA of 0.7 after 2 months. Angiography showed a perivenular infiltration that reminded us of frosted branch angiitis. General laboratory tests and serology for cytomegalovirus and Epstein–Barr virus were requested, and the patient was referred to the internal medicine department to rule out systemic diseases. Conclusions: Serial multimodality imaging is very useful in the follow‐up of patients with venous occlusions. It allows us to observe atypical complications such as vasculitis found in the context of a patient who suffered a venous branch occlusion. Vasculitis can be found in the context of an ocular disease or associated with diseases such as Bechet's disease, Sarcoidosis, Multiple Sclerosis, Lupus, Polyarteritis nodosa, Sjogren's disease, Relapsing polychondritis, Antiphospholipid antibodies, Syphilis, Whipple's disease, Cytomegalovirus infection, leukaemia or lymphomas. Despite the growing popularity of OCT, we cannot ignore the importance of fluorescein angiography for the follow‐up of these cases. [ABSTRACT FROM AUTHOR]

Purpose: To report by multimodality imaging the follow‐up of a patient with posterior uveitis presenting serpiginous choroiditis (SC). To highlight the importance of autofluorescence in the follow‐up of patients with atrophic scarring due to CS. Methods: We present an observational case of SC documented photographically. Clinical data were gathered retrospectively from several visits. The data included corrected visual acuity (BCVA), fundus examination, optical coherence tomography (OCT) and autofluorescence (AF). Results: Periodic revision of a 49‐year‐old female being followed up for SC secondary to tuberculosis. Mantoux test was positive in 2010 and she was treated correctly. Twelve years later, BCVA was hand movements in the right eye and in the left eye 20/40. Fundus examination revealed no presence of vitritis and atrophic scars post choroiditis serpiginosa. OCT displayed disruption of outer retinal layers. AF revealed atrophy plaque with a new diffuse hypoautofluorescence halo surrounding hyperautofluorescent rim. Aqueous humour and vitreous sample results were negatives. Finally, the lesion was diagnosed as a serpiginous choroiditis. She was treated with corticosteroid and biological therapy to improve her visual acuity. It should suggest a reactivation of SC the appearance of a new atrophy plaque with ill‐defined creamy rim, early block and diffuse oozing at late times, choroidal hypoperfusion, diffuse hypoautofluorescence halo surrounding hyperautofluorescent rim and disruption of outer retinal layers with ellipsoid loss. Conclusions: A differential diagnosis should be made between SC and posterior uveitis secondary to tuberculosis. Multimodal imaging by autofluorescence is important for the diagnosis and follow‐up of patients with atrophic scarring due to SC. Differential diagnosis of cause posterior uveitis is essential for the monitoring and treatment. In inflammatory diseases always rule out infection prior to corticosteroid treatment or biological therapy. [ABSTRACT FROM AUTHOR]

Purpose: To describe an observational case of closed‐angle glaucoma secondary to uveal effusion syndrome after a first episode of posterior scleritis. Methods: Morales Meseguer University Hospital. Ophthalmology service. Uveitis section. Results: A 76‐year‐old woman presented to the emergency department with a red, painful right eye (RO) and decreased visual acuity (VA). Initial VA was light perception and intraocular pressure was 40 mmHg, presenting a narrowed chamber and corticonuclear cataract. The fundus was not assessable due to media opacity. Optical coherence tomography showed choroidal folds in the left eye, and the OD was unapproachable. B‐mode ocular ultrasound showed scleral thickening of 2 mm in both eyes and a superior temporal hematic choroidal detachment in the left eye. She was diagnosed with acute glaucoma secondary to uveal effusion after the first outbreak of posterior scleritis. In the emergency department she was treated with intravenous mannitol, acetazolamide orally and hypotensive eye drops. Acute angle‐closure glaucoma and choroidal detachment remitted under systemic steroid treatment, cycloplegic eye drops and topical hypotensive agents. After screening for pathologies associated with posterior scleritis, idiopathic origin of the condition was concluded. Conclusions: Patients with posterior scleritis may develop uveal effusion syndrome, which can lead to secondary angle‐closure glaucoma. A screening for pathologies associated with posterior scleritis (Wegener's, rheumatoid arthritis, herpes zoster, tumours, porphyria, post‐surgical or pharmacological causes) should be performed, although most cases are idiopathic. Treatment differs from glaucoma due to pupillary block, being necessary the use of systemic corticosteroids. [ABSTRACT FROM AUTHOR]