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Purpose: The COVID-19 pandemic affected medical practice worldwide due to interventions to prevent spreading. Its effect on ophthalmology practices in Latin America has not yet been explored. We aimed to assess the perceptions about the pandemic from countries' ophthalmological national and subspecialty retina societies affiliated to the Pan-American Association of Ophthalmology (PAAO). Patients and Methods: A survey-based study of leaders of national ophthalmological and retinal societies was conducted. The survey was sent by email to 30 societies, from which 20 responded (12 countries, 66.6% response rate). It included closed- and open-ended questions about (1) operational capacity and precautions, (2) telemedicine and virtual care, (3) procedures, and (4) post-pandemic considerations. Results: There was a marked decline in ophthalmology patient visits (80-95%) and elective surgeries (90%) during 2020 compared to before the pandemic. Precautions like temperature checks, mask usage, and social distancing were widely implemented while personal protective equipment (PPE) availability varied. Telemedicine use was limited due to lack of experience with it. Reopening plans focused on maintaining precautions and gradually resuming activities. Economic and security concerns were raised, and adherence to guidelines was emphasized. Respondents acknowledged the need to adapt to a "new normal". Long duration drugs, fewer imaging studies, and shorter wait times were preferred; however, availability of long duration drugs was limited. Conclusion: The pandemic impacted ophthalmology in Latin America, with reduced patient visits, procedures, and surgeries. Delayed treatment and complications were likely the result of the pandemic.

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El Cross-Linking corneal es un procedimiento utilizado en oftalmología principalmente para el tratamiento del queratocono, la ectasia corneal más frecuente. A pesar de su baja tasa de complicaciones, no es una técnica exenta de ellas. Entre las principales complicaciones se encuentran el haze y el melting corneal, ambas poseen una fisiopatología que no está totalmente esclarecida. Se realizó una revisión bibliográfica sobre la asociación entre el uso de quinolonas y el daño corneal frente a la exposición de luz UV. También se plantearon factores inherentes al paciente que se han relacionado al aumento de complicaciones. Se determinó que la radiación UV produce daños en aquellos tejidos sometidos previamente a tratamiento con quinolonas siendo de suma importancia la correcta anamnesis para seleccionar a los candidatos al procedimiento. (AU)

Corneal Cross-Linking is a procedure used in ophthalmology mainly for the treatment of keratoconus, the most frequent corneal ectasia. Despite its low complication rate, it is not an exempt technique. Among the main complications are haze and corneal melting, both have a pathophysiology that is not fully clarified. A bibliographic review of the association between the use of quinolones and corneal damage versus UV light exposure was performed. Inherent patient factors that have been related to increased complications were also raised. It was determined that UV radiation causes damage to these tissues, sometimes prior to quinolone treatment, with the correction of the anamnesis being of utmost importance to select the candidates for the procedure.

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The higher prevalence rates of depression in visually-impaired individuals than the general population indicates that the condition per se increases the risk of depression. A person that is aware of the progressive loss of visual acuteness may have feelings of insecurity, anxiety, loss of independence and changes in social functioning, leading to depression. Several studies assessing the association between depressive symptoms and severity of vision loss have yielded inconsistent results. Some do not show any association, whereas others reported that depression severity is higher in those with substantial vision loss. The general aim of this manuscript was to determine the prevalence of depression in patients diagnosed with legal blindness in the Eye Care Service at the Hospital Córdoba between June 2016 and June 2017. The study sample consisted of 41 patients. The level of depression was assessed using the Zung scale and the degree of dependence in daily life activities was defined using the Barthel index. Data was anonymized for inclusion in a computer database and statistical confidentiality was protected. Data was analyzed using InfoStat statistical software. The results revealed a relation between legal blindness, degrees of dependency and depressive symptoms in patients of the Eye Care Service of the Hospital Córdoba. It is very important for health professionals to be trained to detect early signs and symptoms of depression and have the necessary tools for such an approach.

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PURPOSE: Corneal crosslinking by UV light (UV-CXL) has become a popular treatment for keratoconus and corneal ectasia. Fluoroquinolones (FQs), commonly administered topically before UV-CXL, are known to be phototoxic to the skin and lens. The purpose of this study was to investigate phototoxic effects of topical FQ treatment on murine corneas before UV-CXL, in which the corneal epithelium was kept intact. METHODS: Murine corneas were treated with various antibiotics with or without riboflavin before UV-CXL. At 24 h, the animals were sacrificed, and the corneas were analyzed for histologic evidence of inflammation and apoptosis and for expression of apoptosis markers BAX and caspases 3 and 9 and for expression of matrix metalloproteinase 9 (MMP-9). Spectrofluorometric analysis was performed. RESULTS: Corneas treated with topical FQ with or without riboflavin before UV-CXL showed mild corneal stromal inflammation, apoptosis by both terminal deoxynucleotidyl transferase dUTP nick end labeling staining and increased expression of BAX gene and caspases 3 and 9 by densitometric analysis. Untreated corneas, corneas treated with azithromycin before UV-CXL, and corneas undergoing UV-CXL without any antibiotic or riboflavin pretreatment showed normal histology, no staining for apoptosis, and no increased production of apoptosis markers by polymerase chain reaction. CONCLUSIONS: The phototoxic effects of FQs on the cornea may lead surgeons to consider another antibiotic class for prophylaxis against infectious keratitis in UV-CXL. These effects, along with the known cytotoxic effects of FQs independent of UV radiation, may contribute to some of the complications of corneal UV-CXL. Dosage studies may be warranted.

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A 52-year-old man presented with a 5-year history of multiple bilateral apocrine hidrocystomas of the eyelids. For the past 3 years, the patient had developed a mechanical ectropion of the right inferior eyelid secondary to progressive enlargement of the lesions. Different therapeutic options were discussed with the patient. Surgical excision of all lesions was performed under local anesthesia. There was no recurrence after 15 months of follow-up.

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Purpose. To describe the presence of secretory leukocyte protease inhibitor (SLPI), a cationic peptide with antimicrobial and antiprotease activity in the innate immune reaction in a rat model of Staphylococcus aureus keratitis. Methods. Forty female Lewis rats were divided into 2 groups: the infectious keratitis and the epithelial defect groups. Eyes were processed for immunohistochemical studies for SLPI, interleukin-1, interleukin-6, tumor necrosis factor-alpha, and matrix metalloproteinase-8. Results. Immunohistochemical studies confirmed high levels of SLPI, IL-1, IL-6, TNF-alpha, and MMP-8 expression in eyes with S. aureus keratitis and with epithelial defects, in contrast to undetectable SLPI expression in the normal control corneas. Conclusions. To our knowledge, this paper is the first to demonstrate the presence of SLPI with increased amounts of proinflammatory cytokines in inflamed and infected corneas.

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We report a case of acute rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) surgery in a highly myopic patient. Fourteen hours postoperatively, the uncorrected visual acuity was counting fingers in the left eye. Slitlamp examination revealed significant anterior chamber reaction with fibrin-like material. Fundus examination revealed 2 inferior retinal horseshoe tears associated with an RD. Preoperative fundus examination with scleral depression may detect predisposing retinal lesions in highly myopic patients. Further study is required to evaluate the relationship between LASIK, acute postoperative RRD, and predisposing factors.

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PURPOSE: To describe the presence of secretory leukocyte protease inhibitor (SLPI), a cationic peptide with antimicrobial and antiprotease activity, in the innate ocular immune reaction in a rat model of Staphylococcus aureus endophthalmitis. METHODS: Seventy-five female Lewis rats were divided into three groups: the endophthalmitis group received an intravitreal injection of 65 colony-forming units of viable S. aureus, the vehicle-injected group received balanced sterile saline solution (BSS), and the control group was not injected. Eyes were enucleated at 24 and 48 hours and processed for immunohistochemical staining and Western blot studies for SLPI. RESULTS: In S. aureus endophthalmitis eyes, there was strong immunostaining for SLPI in the retina and vitreous with associated neutrophilic infiltrates. At 48 hours, corneas also stained for SLPI. Western blots confirmed increased SLPI expression in all infected eyes. By immunohistochemical assays, SLPI was absent in the BSS and control eyes. The causative pathogen was identified in all samples from the endophthalmitis group by traditional culture methods. CONCLUSIONS: To our knowledge, this report is the first to demonstrate the presence of SLPI in the inflamed cornea, vitreous, and retina tissues of rat eyes with S. aureus endophthalmitis, suggesting that SLPI has an active role in the innate immunity of the eye. Release of SLPI by inflammatory cells in the anterior and posterior segments may contribute to the host defense response against infectious endophthalmitis.

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We describe a case of a 47-year-old woman who underwent bilateral laser in situ keratomileusis (LASIK) for the correction of myopia and astigmatism. Two months later a residual refractive error was present in both eyes. LASIK retreatment was decided and performed the following day. Twenty-four hours after the procedure, the patient reported myodesopsia in both eyes. Funduscopic examination revealed a complete bilateral posterior vitreous detachment confirmed by kinetic ultrasound. Visual disturbance in both eyes continued to be present after 10 months of follow-up. Sudden changes in intraocular pressure related to suction ring use might be the cause of posterior vitreous detachment in this patient.

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