Nicolas Crim

Impact of changing oxygenation policies on retinopathy of prematurity in a neonatal unit in Argentina

Aims To assess the impact of different oxygenation policies on the rate and severity of retinopathy of prematurity (ROP). Methods Between January 2003 and December 2006, infants of 1500 g birthweight (BW) or less and/or 32 weeks gestational age (GA) or less, and larger, more mature infants with risk factors for ROP were examined through three different time periods: period 1: high target oxygen saturation levels (88–96%) and treatment at threshold ROP; period 2: low target oxygen saturation levels (83–93%) and treatment at threshold ROP; period 3: low target oxygen saturation and treatment at type 1 ROP. Results Type 1 ROP was detected more frequently in babies of 32 weeks GA or less (50/365, 13.7%) than in more mature babies (15/1167, 1.3%; p<0.001). The rate of type 1 ROP in period 1 was 6.9%; period 2, 3.6% and period 3, 1.8%. Rates of stage 3 ROP declined over time in both BW/GA groups (from 9.0% to 4.1% to 2.0%) as did rates of plus disease (from 7.5% to 3.6% to 1.8%). Mean BW and GA declined from period 1 to period 3, and death rates remained unchanged. 74.4% of babies received all the examinations required; 48.1% of treatments were undertaken after discharge from the neonatal unit. Conclusions Lower target oxygen saturation was associated with a lower rate of severe ROP without increasing mortality, and changed the characteristics of affected babies. Screening criteria need to remain wide enough to identify all babies at risk of ROP needing treatment.

Endophthalmitis Prophylaxis in Cataract Surgery: Overview of Current Practice Patterns Around the World

BACKGROUND Acute-onset postoperative endophthalmitis after cataract surgery remains a rare but important cause of visual loss. There is no global consensus regarding the optimal strategies for prophylaxis of endophthalmitis and practices vary substantially around the world, especially with respect to the use of intracameral antibiotics. The European Society of Cataract & Refractive Surgeons in a randomized clinical trial (2007) reported an approximately 5-fold reduction in endophthalmitis rates associated with the use of intracameral cefuroxime. Despite this report, the use of intracameral antibiotics has not been universally adopted. METHODS Various endophthalmitis prophylaxis patterns around the world (including the United States, Canada, Australia/New Zealand, Japan, China, India, Indonesia, South Africa, Argentina, Russia, Sweden and Mexico) are compared. Each contributing author was asked to provide similar information, including endophthalmitis rates based on published studies, current practice patterns, and in some cases original survey data. Various methods were used to obtain this information, including literature reviews, expert commentary, and some new survey data not previously published. RESULTS Many different practice patterns were reported from around the world, specifically with respect to the use of intracameral antibiotics. CONCLUSION There is no worldwide consensus regarding endophthalmitis prophylaxis with cataract surgery.

In situ carcinoma of the conjunctiva: surgical excision associated with cryotherapy

Background Although frequently underdiagnosed, squamous cell carcinoma is the most commonly observed malignancy of the conjunctiva. Multiple different treatments have been proposed to date. The purpose of this paper is to report our experience in the treatment of In situ carcinoma of the conjunctiva by surgical excision associated with cryotherapy. Methods Four eyes in four consecutive patients (two men and two women) of average age 53.2 (range 39–71) years at the time of diagnosis of ocular surface squamous neoplasia were treated by simple surgical excision and cryotherapy of the resulting surgical bed margins. In all cases, the diagnosis of in situ carcinoma was confirmed histopathologically. Results On histopathology, the edges of the surgical specimens were free of malignant cells in three of four patients. All patients showed excellent evolution without recurrence. Mean follow-up was 6.5 (range 2–14) years. Conclusion In situ carcinoma of the conjunctiva may be simply and successfully treated with surgical excision and cryotherapy.

Climatic Droplet Keratopathy in Argentina: Involvement of Environmental Agents in Its Genesis Which Would Open the Prospect for New Therapeutic Interventions

Climatic droplet keratopathy (CDK) is a degenerative corneal disease of unknown etiology. We described CDK for the first time in Latin America in the Argentinean Patagonia (El Cuy). A deeper knowledge of CDK pathogenic mechanisms will provide new therapeutic strategies. For that reason we investigated the prevalence of CDK in El Cuy and its existence in other 3 provinces with similar climate. Patients eyes were examined, habits throughout lives were inquired about, and serum ascorbate (sAA) was determined. All individuals work outdoors for most of the day. All regions had normal O3 levels. Individuals from regions 1, 2, and 3 had very low consumption of vegetables/fruits and low sAA levels. Conversely, region 4 individuals had balanced diet and higher sAA concentrations. CDK was only found in region 3 where individuals had partial deficiency of sAA and did not use eye protection. No CDK was found in regions 1 and 2 where individuals had similar work activities and dietary habits to those in region 3 but wear eye protection. No disease was found in region 4 where individuals work outdoors, have balanced diet, and use eye protection. To summarize, the CDK existence was related not only to climate but also to the dietary habits and lack of protection from sunlight.

Válvula de Ahmed en glaucoma refractario. Comportamiento de la presión intraocular a 24 meses

Purpose: To evaluate the results of Ahmed valve implantation in refractory glaucoma patients. Patients, Material and Methods: 14 eyes in 13 patients with refractory glaucoma to medical treatment, which underwent an implantation of an Ahmed valve between August 2007 and April 2015, with a minimum follow up of 24 months were retrospectively reviewed. Success was defined as a postoperative intraocular pressure (IOP) between 5 and 22 mmHg without antiglaucomatous medications, relative success when postoperative IOP was within that range but with one or more glaucoma drops, and failure when postoperative IOP was < 5 or > 22 mmHg or when the valve was explanted. Results: An absolute success was obtained in 14.29% (n = 1) of patients with primary open angle glaucoma a relative success in 57.14% (n = 4), and a Correspondencia: *Julio A. Urrets-Zavalía E-mail: julioaurrets@gmail.com Disponible en internet: 06-04-2018 Rev Mex Oftalmol. 2018;92(2):94-100 www.rmo.com.mx Fecha de recepción: 17-02-2017 Fecha de aceptación: 24-08-2017 DOI: 10.24875/RMO.M18000019 0187-4519/© 2017 Sociedad Mexicana de Oftalmología. Publicado por Permanyer México. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). Si n co nt ar c on e l c on se nt im ie nt o pr ev io p or e sc ri to d el e di to r, no p od rá r ep ro du ci rs e ni f ot oc op ia rs e ni ng un a pa rt e de e st a pu bl ic ac ió n.

Clinical, Functional and Structural Studies of Humans and Merino Sheep Corneas from Two Different Regions of Argentina

Objective: The purpose of our work was to study and compare the cornea and tear film of people and sheep inhabiting in a region of Argentinean Patagonia (PATG), and in a geographically and climatically different region in the Argentinean Pampa (CAPT). Methods: Using cross sectional study, corneal examinations were performed in people and Merino sheep inhabiting PATG and CAPT regions, respectively. All people completed a questionnaire related to work activity, diet, and the use of hats or sunglasses during their life. Eyes from all participants were examined with a portable handheld slitlamp biomicroscope (BM) to evaluate corneal appearance, epithelium integrity, and transparency. Later on, in a subgroup of participants we studied eyeblinking frequency (EBF), ocular surface staining (FS), breakup time (BUT), Schirmer Tear Test (STT), corneal structure using confocal laser scanning microscopy (CLSM) and light microscopy (LM), and concentrations of serum ascorbate (sAA). Results: BM studies revealed numerous cases of Climatic Droplets Keratopathy (CDK) only in people inhabiting the PATG region. CLSM studies confirmed typical punctiform deposits at the Bowman´s layer in CDK patients living in that region. CLSM images from sheep did not show any abnormalities at the Bowman´s layer but exhibited small hyper reflective dots at the epithelium only in animals pasturing in the PATG region. FS and EBF mean values were significant higher in sheep grazing in the PATG region (p <0.05). No differences were found in surface eye tests when people from both regions were analyzed. Low sAA levels were found only in CDK people living in PATG region. Conclusions: CDK is a multi-factorial disease not only associated to harsh climate. We provide data that low sAA levels can play a role in its genesis in Patagonia patients’... Sheep pasturing in this region with a high prevalence of CDK have high concentration of sAA and did not present any sub epithelial corneal abnormalities.

Bevacizumab for the treatment of a complicated posterior melanocytoma

Purpose To present a case of a complicated posterior melanocytoma that was successfully treated with intravitreal bevacizumab. Case report A 50-year-old Caucasian man was referred with sudden-onset metamorphopsia and decreased vision in his right eye over the course of the last 2 months. His best-corrected visual acuity was 20/80 and poorer than Jaeger 14 in the right eye, and 20/20 and Jaeger 1 in his left eye. In the right fundus, there was a melanocytic lesion occupying the inferotemporal quadrant of the optic disk, extending to the adjacent choroid inferiorly; optic nerve edema, superotemporal retinal vein dilatation, and subretinal fluid under the macula and nasal half of the posterior pole were observed, and a subretinal choroidal neovascularization complex was observed adjacent to the superotemporal margin of the optic disk, confirmed by fluorescein angiography, surrounded by a dense subretinal hemorrhage. Optical coherence tomography showed retinal edema and detachment of neurosensory retina. The patient was treated with three consecutive doses on a monthly basis of intravitreal 1.25 mg/0.05 mL bevacizumab. Visual acuity recovered rapidly, and at 4 months after treatment, it was 20/20 and Jaeger 1, with complete resolution of macular edema and subretinal fluid and hemorrhage. After 3 years of follow-up, best-corrected visual acuity remained stable, macular area was normal, and there was no evident optic nerve edema, retinal vein caliber and aspect were normal, and there was no significant change of the tumor. Fluorescein angiography only evidenced late staining of choroidal neovascularization scar, and optical coherence tomography showed a normal macular anatomy. Conclusion Intravitreal bevacizumab was effective in the treatment of choroidal neovascularization, optic nerve edema, venous dilatation, and local capillary telangiectasia, complicating an optic disk melanocytoma.