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Background: Describe complications and clinical outcomes of heavy silicone oil (HSO) Oxane HD® use as an alternative to overcome the challenges of performing vitrectomy to treat tractional and rhegmatogenous retinal detachments with proliferative vitreoretinopathy (PVR)., Methods: A retrospective, observational study was performed on patients from one center from August 2014 to Aug 2023. It was included patients who underwent surgery using HSO Oxane HD® to treat rhegmatogenous retinal detachment with PVR or mixed tractional and rhegmatogenous diabetic retinal detachment. Severely ill patients who could not attend to follow up were excluded. The primary outcome was successful retinal attachment at first postoperative month. A descriptive analysis was performed., Results: Among the 31 patients, 29 (93.5%) underwent surgeries due to rhegmatogenous retinal detachment and two (6.5%) for diabetic retinal detachment. The primary anatomic success was achieved in 27 (87.1%) patients. At the final visit, 17 (56.6%) had vision better than 20/400 (range, 20/30 to light perception). The vision was stable or improved in 22 (76.8%) patients at the end of follow-up. Nineteen (61.3%) patients required hypotensive eye drops after HSO use and twelve (38.7%) still required hypotensive eye drops at the final follow-up; three (9.7%) patients required additional glaucoma surgeries., Conclusions: HSO is safe and useful for complex retinal detachments cases specially with inferior tears and PVR. Ocular hypertension is frequent and usually clinically controlled with hypotensive eyedrops. Close postoperatively follow-up is advised due to the ocular complications, particularly elevated intraocular pressure and emulsification., (© 2024. The Author(s).)

Background: To describe the incidence of endophthalmitis and the treatment outcomes of acute bacterial endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in a Brazilian hospital. The analysis was based on the timing of infection after intravitreal injection, culture results, visual acuity, and the presence of epiretinal membrane after a 1-year follow-up period, spanning nine years., Methods: This retrospective case series, conducted over a 9-year period, aimed to evaluate the treatment outcomes of acute endophthalmitis following intravitreal Bevacizumab injections. The inclusion criteria involved a chart review of 25 patients who presented clinical signs of acute endophthalmitis out of a total of 12,441 injections administered between January 2011 and December 2019. Negative culture results of vitreous samples or incomplete data were excluded. Ultimately, 23 patients were enrolled in the study. Eight patients were treated with intravitreal antibiotic injections (IVAI) using vancomycin 1.0 mg/0.05mL and ceftazidime 2.25 mg/0.05mL, while 15 patients underwent pars plana vitrectomy (PPV) followed by intravitreal antibiotic injections at the end of surgery (IVAIES). The main outcome measures were the efficacy of controlling the infection with IVAI as a standalone therapy compared to early PPV followed by IVAIES. Data collected included pre-infection and one-year post-treatment best corrected visual acuity (BCVA), optical coherence tomography (OCT) abnormalities, and enucleation/evisceration rates. To compare groups, Mann-Whitney and ANOVA tests were employed for statistical analysis., Results: The incidence rate of bacterial endophthalmitis was 0.185% (1/541 anti-VEGF injections), with the highest infection rates observed in 2014 and 2017. Patients presented clinical symptoms between 2 and 7 days after injection. The most common isolated organisms were coagulase-negative Staphylococci and Streptococci spp. Treatment outcomes showed that both IVAI and PPV + IVAIES effectively controlled the infection and prevented globe atrophy. After one year, the PPV group with BCVA better than Light Perception had a significantly better BCVA compared to the IVAI group (p 0.003). However, PPV group had higher incidence of epiretinal membranes formation compared to the IVAI group. (P 0.035) CONCLUSION: Anti-VEGF injections carry a risk of developing acute bacterial endophthalmitis. Isolated antibiotic therapy could be an effective treatment to control the infection, but performing PPV + IVAIES as a primary treatment showed promising results in terms of improving BCVA after one year, despite a higher rate of epiretinal membrane formation. Further studies are needed to confirm these findings., (© 2023. The Author(s).)

Background: Retinopathy of prematurity (ROP) is a vasoproliferative disease responsible for more than 30 000 blind children worldwide. Its diagnosis and treatment are challenging due to the lack of specialists, divergent diagnostic concordance and variation in classification standards. While artificial intelligence (AI) can address the shortage of professionals and provide more cost-effective management, its development needs fairness, generalisability and bias controls prior to deployment to avoid producing harmful unpredictable results. This review aims to compare AI and ROP study's characteristics, fairness and generalisability efforts., Methods: Our review yielded 220 articles, of which 18 were included after full-text assessment. The articles were classified into ROP severity grading, plus detection, detecting treatment requiring, ROP prediction and detection of retinal zones., Results: All the article's authors and included patients are from middle-income and high-income countries, with no low-income countries, South America, Australia and Africa Continents representation.Code is available in two articles and in one on request, while data are not available in any article. 88.9% of the studies use the same retinal camera. In two articles, patients' sex was described, but none applied a bias control in their models., Conclusion: The reviewed articles included 180 228 images and reported good metrics, but fairness, generalisability and bias control remained limited. Reproducibility is also a critical limitation, with few articles sharing codes and none sharing data. Fair and generalisable ROP and AI studies are needed that include diverse datasets, data and code sharing, collaborative research, and bias control to avoid unpredictable and harmful deployments., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To examine the epidemiological characteristics of children undergoing cataract surgery at a referral center in Sao Paulo State, Brazil, as well as the facts surrounding treatment delays., Methods: In this transversal observational study, 240 operated eyes from 178 children undergoing cataract surgery were reviewed. The following aspects were analyzed: epidemiological and clinical characteristics, parental observations, red reflex test, operated eye, and age at cataract diagnosis and surgery., Results: The mean ages at the first visit and cataract surgery were 48.9 months (SD=50.0 months) and 64.5 months (SD= 55.4 months), respectively. The most critical sign adverted by parents was leukocoria. The red reflex test was performed on two-thirds of the children, with abnormal results in 28.0%. A family history of cataracts was evident in 30 (20,9%) children (n=144). Previous ocular surgery was found in 37 (16,6%) of the eyes (n=223), anterior segment disorders in 20 (9,0%) eyes (n=221), strabismus in 21 (9,5%) of the eyes (n=220), and nystagmus in 38 (24,4%) of the children (n=156)., Conclusions: One of the causes for the delay in admission may have been the failure to complete the red reflex. In terms of etiology, heredity was the most crucial component. The presence of strabismus and nystagmus in many of these children points to late diagnosis. The most significant impediments to adequate cataract treatment in children were the lack of referral programs and children's specialized ophthalmologic centers, in addition to the restricted number of support professionals trained in the field and pediatric ophthalmology specialists.

Purpose: To analyze the epidemiological profiles of evisceration and enucleation cases in the ophthalmologic emergency department of a Brazilian tertiary hospital., Methods: Patients treated in the ophthalmologic emergency department of Hospital São Paulo (Universidade Federal de São Paulo) during the period 2013 to 2018 were retrospectively evaluated. Urgent cases of evisceration or enucleation surgery were included, and elective cases were excluded. The following information was extracted from the patients' medical records: demographic data, immediate and associated reasons for the surgical procedure, informed visual acuity, symptom duration until ophthalmologic care, complications, distance from the residence to the tertiary hospital, and time of hospitalization., Results: In total, 61 enucleations and 121 eviscerations were included in this study. The patients had a mean age of 63.27 ± 18.68 years. Of the patients, 99 were male (54.40%), and 83 were female (45.60%). The indications for evisceration or enucleation were corneal perforation with (44.50%) and without (23.63%) signs of infection, endophthalmitis (15.38%), ocular trauma (14.29%), neoplasia (0.55%), burn accident (1.10%), and phthisis bulbi (0.55%). The self-reported visual acuity was no light perception (87.36%) or light perception (1.10%). However, 3.30% of the patients did not cooperate with the examination, and no information on visual acuity was available for the remaining 8.24%. The mean symptom duration before ophthalmologic care was sought was 18.32 days. Two patients had sympathetic ophthalmia after evisceration., Conclusions: More eviscerations than enucleations were performed throughout the study period. The most common demographic characteristics were age >60 years and male sex. The main indications for urgent evisceration and enucleation procedures were corneal perforation with and without infection, endophthalmitis, and ocular trauma. The findings from this study could guide clinicians in performing preventive measures to avoid destructive eye procedures.

Abstract: Chromovitrectomy, the intraocular application of dyes to assist visualization of preretinal tissues during vitreoretinal surgery, was introduced to avoid ocular complications related to internal limiting membrane peeling, inadequate removal of the vitreous, and incomplete removal of epiretinal membranes. Since 2000, chromovitrectomy has become a popular approach among vitreoretinal specialists. The first vital dye used in chromovitrectomy, indocyanine green, facilitated identification of the fine and transparent internal limiting membrane. Following indocyanine green, trypan blue was introduced to identify epiretinal membranes, and triamcinolone acetonide stained the vitreous well. Recently, additional natural dyes such as lutein and anthocyanin from the açaí fruit have been proposed for intraocular application during vitrectomy. The main goal of this review was to study the role of vital stains in chromovitrectomy and report the latest findings in the literature., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)

Background: Cat scratch disease is a systemic infectious illness caused by the bacterium Bartonella henselae. The most common ophthalmological involvement due to infection by Bartonella is Parinaud oculoglandular syndrome, whereas the most common posterior segment findings are neuroretinitis and subsequent late macular star. Moreover, other findings, such as retinal or subretinal lesions, intermediate uveitis and angiomatous lesions, may be present., Case Presentation: A 37-year-old female patient with retinal findings and serological confirmation of Bartonella infection was evaluated via multimodal retinal exams. The patient received treatment with doxycycline 100 mg twice daily for 2 weeks. One month after treatment, complete improvement of her visual scotoma symptoms was confirmed. A swept-source optical coherence tomography exam also showed decreases in the size and intraretinal extension of the lesion. Improvement of light perception at the affected area was confirmed by microperimetry., Conclusions: Bartonella henselae infection, particularly retinitis, can present a variable spectrum of clinical and ophthalmological findings. Multimodal retinal exams can clearly identify lesion characteristics, thus providing important information for diagnosis and the evaluation of lesion improvement after antibiotic treatment.

Purpose: To report a patient presenting a retinal pigment epithelial tear in which optical coherence tomography angiography enabled the visualization of subfoveal choroidal neovascularization (CNV) not evidenced by the fluorescein angiography. She was treated with 3 monthly intravitreous anti-VEGF injections and intraretinal fluid resolution occurred., Methods: Observational case report., Results: A 62-year-old Caucasian woman presented with decreased visual acuity in the right eye for 3 months. Fundus biomicroscopy revealed a yellowish macular lesion associated with intraretinal hemorrhage. Fluorescein angiography showed a large hyperfluorescent area consistent with window defect. Optical coherence tomography showed a retinal pigment epithelial tear with subretinal fluid. However, there was no clear evidence of CNV on fluorescein angiography or OCT. Optical coherence tomography angiography confirmed the presence of an active CNV by the visualization of the neovascular network in the region corresponding to the scrolled up retinal pigment epithelium., Conclusion: This case report demonstrates that optical coherence tomography angiography can be useful to confirm the presence of CNV in cases where fluorescein angiography and OCT cannot establish the diagnosis. The reported case suggests the applicability of optical coherence tomography angiography in patients in whom retinal pigment epithelial tear is detected and associated CNV is suspected.

Background: Portal hypertension is one of the complications of cirrhosis and is associated with numerous systemic manifestations, including renal, brain, pulmonary, cardiac and vascular changes. In routine ophthalmological examinations performed at our service, we observed that some children diagnosed with portal hypertension had increased retinal vascular tortuosity., Objective: 1. To evaluate the presence of retinal vascular abnormalities (vascular tortuosity) in children diagnosed with portal hypertension; 2. To investigate the association between retinal vascular tortuosity and the presence of gastroesophageal varices in these children; 3. To evaluate the use of clinical and laboratory parameters to predict the presence of gastroesophageal varices in children with portal hypertension., Methods: This was a cross-sectional and observational study that included patients aged <18 years with a diagnosis of portal hypertension. The participants included were submitted to dilated fundus examination and fundus photography with Visucam (Carl Zeiss Meditec AG) device. Besides, clinical and laboratorial data were collected from the patients' medical records., Results: A total of 72 patients were included in this study, and 36% of them had an increase in retinal vascular tortuosity. Platelet count (P=0.001), bilirubin dosage (P=0.013) and aspartate transaminase dosage (AST) (P=0.042) were associated with the presence of gastroesophageal varices in digestive endoscopy. There was no association between retinal vascular tortuosity and the presence of gastroesophageal varices (P=0.498)., Conclusion: The results of this study suggest that platelet count, bilirubin dosage, and aspartate transaminase dosage were associated with the presence of gastroesophageal varices in digestive endoscopy. Regarding the retinal findings, we found that there was an increase in retinal vascular tortuosity in 36% of pediatric patients, but no association was found with the presence of gastroesophageal varices.

Background: To evaluate the epidemiology of endophthalmitis cases related to ocular trauma, including visual acuity during and 1 year after trauma, source of trauma and method of treatment., Methods: A retrospective study analyzed the epidemiological data of patients with a clinical presentation of endophthalmitis after ocular penetrating trauma between January 2012 and January 2017 at Escola Paulista de Medicina/UNIFESP, a hospital in São Paulo, SP, Brazil., Results: A total of 453 patients with antecedent open globe trauma were evaluated, among these, 30 patients with suspected endophthalmitis. All patients were male. The time interval between trauma and ophthalmological evaluation and collection of vitreous and aqueous material was 1 day in 36.66%, 2-7 days in 43.44%, 7-14 days in 10% and more than 15 days in 10% of patients; 66.66% had positive cultures. 11 patients had intraocular foreign body. One year after trauma, visual acuity was classified as no light perception (NLP) in 33.33%, light perception in 6.66%, hand motion in 13.33%, counting fingers in 13.33%, and better than 20/400 in 20% of patients. Considering presence of intraocular foreign body, initial visual acuity and symptoms onset time, only initial visual acuity showed as better prognostic factor in final visual acuity., Conclusion: Endophthalmitis is a severe ocular inflammatory condition that may lead to irreversible vision loss. Initially only one patient had visual acuity of NLP, but after 1 year, 33% showed visual acuity of NLP, and only 20% had visual acuity better than 20/400, what is consistent with a severe infection with a guarded prognosis. The high incidence of endophthalmitis after ocular penetrant trauma justifies distinct treatment and greater attention., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2019.)

Background: Inflammatory bowel disease (IBD) is a systemic inflammatory disease and is classified as Crohn's disease (CD) or ulcerative colitis (UC) depending on the extent of gastrointestinal tract involvement. IBD can be associated with extraintestinal findings, such as fever, weight loss, arthralgia, and mucocutaneous lesions, as well as hepatic, renal and ophthalmological involvement. Clinical parameters and colonoscopy are used to establish the criteria for controlled or non-controlled disease and subsequent definition of treatment. Our objective in the present study was to compare the area of the foveal avascular zone (FAZ) in patients with a diagnosis of IBD during remission and active disease., Methods: 144 eyes of 72 patients with IBD were evaluated via a complete ophthalmological exam. Fundus photography and optical coherence tomography/angiography (OCT/OCTA) were performed with a Topcon Triton. The macula and posterior pole were evaluated by binocular indirect ophthalmoscopy and fundus biomicroscopy. The area of the FAZ was determined via manual delimitation of superficial retinal vascular layers from OCTA with image6.net software. To establish disease activity, we considered the Mayo Score, fecal calprotectin levels, colonoscopy results and clinical parameters. All retinal parameters were evaluated in a blinded manner. Means were compared between groups using the Mann-Whitney test., Results: The participants had a mean age of 42.26 years and included 28 males (38.88%) and 44 females (61.11%). Among the participants, 37 had a diagnosis of CD (51.38%), and 35 had a diagnosis of UC (48.61%). Twenty-five patients (34.72%) had active disease, and 47 (65.27%) were in remission. The area of the FAZ did not differ significantly between the CD and UC groups ( p  = 0.91 for the right eye and p  = 0.76 for the left eye) but did differ significantly between the remission and active disease groups ( p  = 0.01 for the right eye and p  = 0.02 for the left eye)., Discussion: Our study is the first to evaluate the area of the FAZ in patients with IBD via swept-source OCTA. The area of the FAZ did not differ significantly in either eye between the CD and UC groups. However, patients classified as having active disease according to clinical parameters and colonoscopy presented a significant decrease in the area of the FAZ compared with patients in remission. The area of the FAZ is an ophthalmological parameter that can be obtained non-invasively and is increased in ischemic diseases such as diabetic retinopathy. The FAZ may decrease due to vascular engorgement or increased systemic inflammation. This parameter can be used to help determine whether a patient is in remission or active IBD, thus potentially reducing the need for invasive exams during disease follow-up., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Background/purpose: To describe the ocular findings of two infants with congenital Zika syndrome born in São Paulo state, Brazil, outside the primary outbreak region., Methods: Two female infants with congenital Zika syndrome were submitted to a complete screening for infectious diseases, as well as ocular examination, fundus photography, and optical coherence tomography of the retina. One of the infants was submitted to ocular ultrasound., Results: Both children showed positive serology for Zika virus, and other infectious diseases were ruled out. On fundus examination, one newborn had extensive bilateral macular chorioretinal atrophy with hyperpigmented borders associated with gross pigment mottling, as well as atrophic well-limited roundish peripheral lesions in the right eye. Spectral domain optical coherence tomography of the right eye showed complete chorioretinal atrophy in the temporal quadrant. The other infant presented bilateral gross pigment mottling in a paramacular location and a normal optical coherence tomography., Discussion: In this report, the ophthalmologic findings of two infants with Zika syndrome and ocular findings born in São Paulo state, Brazil, are described. Optical coherence tomography findings demonstrate the broad range of retinal damage caused by congenital Zika virus infection., Conclusion: The autochthonous cases of infants with congenital Zika syndrome and ocular findings described in this report demonstrate that Zika virus infection is not limited to northeast Brazil, with the potential for even greater spread.

Background: Inflammatory bowel disease is a systemic inflammatory disease classified as Crohn disease or ulcerative colitis. It could present extra intestinal findings, such as fever, weight loss, arthralgia, mucocutaneous lesions, hepatic, renal and ophthalmological involvement. Among ophthalmological findings, posterior segment findings are present in less than 1% of patients with inflammatory bowel disease, however, these findings could bring definitive visual impairment., Objective: Our study objective was to evaluate ocular posterior segment findings is patients with inflammatory bowel disease, through retinal mapping, color fundus retinography, optical coherence tomography (OCT) and OCT angiography, and compare our results to literature., Methods: We evaluated eighty patients with inflammatory bowel disease through complete ophthalmological examination and posterior segment assessment. Color fundus retinography, OCT and OCT angiography was performed with Topcon Triton (Topcon ® , Tokyo, Japan). Macula and posterior pole were evaluated with binocular indirect ophthalmoscopy and fundus biomicroscopy., Results: Participants mean age was 44.16 years (18.08-68.58), 28 (35%) male patients and 52 (65%) female patients. Thirty-five (44%) with diagnosis of Crohn disease, 41 (52%) patients with diagnosis of ulcerative colitis and 3 (4%) had non-conclusive Crohn disease or ulcerative colitis classification. We found abnormal exams in 21 (26.25%) patients., Conclusion: Our study found similar prevalence of ophthalmological posterior segment commitment compared to previous literature prevalence. The findings were predominantly unrelated to inflammatory bowel disease, rather than primarily related to it. The most prevalent, and non-previous reported, finding was increased arteriolar tortuosity, probably occurs due to systemic vascular impairment in inflammatory bowel disease.