ABSTRACT Purpose: This study aimed to evaluate the total macular thickness as well as the thickness of the inner and outer retinal layers in patients with Parkinson’s disease. It also aimed to verify the correlation of these parameters with motor symptoms and cognitive function. Methods: A total of 46 eyes of 23 patients with Parkinson’s disease and 40 eyes of 20 healthy controls were included in the study. The patients’ cognitive, functional, and nonmotor symptoms were evaluated using the Katz Index of Independence and Pfeffer’s Activities of Daily Living, Mini-Mental State Examination, Frontal Assessment Battery, Schwab and England Staging Scales, and Movement Disorders Society Nonmotor Symptoms Scale. The macular thickness measurements obtained via total, inner, and outer optical coherence tomography were recorded. Furthermore, the correlation of the parameters of optical coherence tomography with cognitive, functional, and nonmotor symptoms was assessed. Results: The scores of the Katz Index of Independence and Pfeffer’s Activities of Daily Living as well as the Movement Disorders Society Nonmotor Symptoms Scale were significantly lower in patients with Parkinson’s disease than in healthy controls. Moreover, the former had greater total macular thickness. The temporal and inferior outer sectors were significantly greater for the ganglion cell complex thickness in patients. A significant correlation was observed between the total macular thickness and the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, Parte III (MDS-UPDRS-III) values. Contrarily, there was a negative correlation between the outer macular thickness and the MDS-UPDRS-III values. Meanwhile, the total macular thickness and ganglion cell complex thickness were significantly correlated with the scores of the Mini-Mental State Examination, Schwab and England Staging Scale, Frontal Assessment Battery, and Katz Index of Independence and Pfeffer’s Activities of Daily Living. In addition, the Schwab and England scale was correlated with the outer macular thickness. Conclusion: The total and inner macular thicknesses at the temporal and inferior outer sectors were greater in patients with Parkinson’s disease than in the control group. These findings indicate that macular thickness may be greater in those with Parkinson’s disease, particularly when associated with mild motor symptoms. In addition, the parameters of the total, inner, and outer optical coherence tomography were significantly associated with motor and nonmotor symptoms as well as cognitive function impairment. Purpose Parkinsons Parkinson s Methods 4 2 functional Pfeffers Pfeffer MiniMental Mini Mental Examination Battery Scales recorded Furthermore assessed Results Moreover SocietyUnified Unified MDSUPDRSIII MDS UPDRS (MDS-UPDRS-III values Contrarily Meanwhile addition Conclusion group impairment

ABSTRACT A young woman presented at our clinic with sudden visual loss in the right eye, recurrent vertigo, and right-sided tinnitus. We performed a complete ophthalmological evaluation. This revealed effects of the condition on the small arterioles of the peripheral retina. Susac syndrome is characterized by the clinical triad of retinal arteriolar occlusions, cochleovestibular manifestations, and encephalopathy (which can be identified by neuroimaging abnormalities). Early diagnosis and immunosuppressive therapy improved the patient's visual acuity and the remission of her other symptoms. Hemi-central retinal artery occlusion is an atypical neuro-ophthalmological finding in this disease. However, its identification as a sign of Susac syndrome may facilitate timely diagnosis and accurate treatment. eye vertigo rightsided sided tinnitus evaluation retina occlusions manifestations which abnormalities. abnormalities . abnormalities) patients patient s symptoms Hemicentral Hemi central neuroophthalmological neuro disease However treatment

ABSTRACT Purpose: To characterize the extracellular vesicle protein cargo in the aqueous humor and plasma of patients with ocular toxoplasmosis. Methods: Aqueous humor and plasma were collected from six patients with active ocular toxoplasmosis and six patients with cataract. Extracellular vesicles were isolated, and western blotting and mass spectrometry were performed for protein analysis. Results: All plasma samples from patients with ocular toxoplasmosis and cataract were positive for the tetraspanins CD63 and TSG101. However, the aqueous humor from patients with ocular toxoplasmosis was positive only for CD63. Sixty-seven new unreported proteins were identified in the aqueous humor and plasma of patients with the ocular toxoplasmosis and cataract. Of the 67 proteins, 10 and 7 were found only in the cataract and ocular toxoplasmosis groups, respectively. In general, these proteins were involved in immune system activation and retina homeostasis and were related to infections and retina-associated diseases. Conclusion: The distinct protein signatures between ocular toxoplasmosis and cataract may be helpful in the differential diagnosis of ocular toxoplasmosis. However, more studies are needed to better understand the role of these proteins in the pathogenesis of ocular toxoplasmosis. Purpose Methods isolated analysis Results CD CD6 TSG101 TSG However Sixtyseven Sixty seven 6 1 groups respectively general retinaassociated associated diseases Conclusion TSG10 TSG1

Abstract Objective: The objective of the study is to compare the optic coherence tomography (OCT) parameters of the healthy and affected sides of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to investigate the relationships between these and the improvement in hearing levels. Methods: A bilateral eye evaluation of patients diagnosed with ISSNHL was performed with OCT. The ganglion cell complex (GCC) and retina nerve fiber layer (RNFL) thickness values were recorded and the differences between the two eyes were examined. Results: An evaluation was made of 39 patients with a mean age of 44.82 ± 14.90 years. The RNFL thickness of the eyes was determined to be mean 89.87 ± 3.65 µm on the affected side and 103.87 ± 3.98 µm on the healthy control side (p = 0.0001). The mean GCC was determined to be mean 90.46 ± 3.49 µm on the affected side and 103.77 ± 3.96 µm on the healthy control side (p = 0.0001). Conclusions: A statistically significant difference was observed between the healthy and affected eyes of patients with ISSNHL with respect to mean GCC and mean RNFL thickness. OCT could be a useful technique for measuring this neural degeneration.

Resumen Objetivo: Comparar e investigar los parámetros de la tomografía de coherencia óptica (OCT) de los lados sanos y afectados de pacientes con pérdida auditiva neurosensorial súbita idiopática (PANSI). Método: La evaluación ocular bilateral de los pacientes diagnosticados con PANSI se realizó con OCT. Se registraron los valores de espesor del complejo de células ganglionares (CCG) y de la capa de fibras nerviosas de la retina (CFNR), y se examinaron las diferencias entre los dos ojos. Resultados: Se evaluaron 39 pacientes, con una edad media de 44.82 ± 14.90 años. Se determinó que el grosor de la CFNR de los ojos era una media de 89.87 ± 3.65 µm en el lado afectado y 103.87 ± 3.98 µm en el lado de control sano (p = 0.0001). Se determinó que el CCG medio era 90.46 ± 3.49 µm en el lado afectado y 103.77 ± 3.96 µm en el lado de control sano (p = 0.0001). Conclusiones: Se encontró una diferencia estadísticamente significativa entre los ojos sanos y afectados de pacientes con PANSI con respecto al CCG medio y al espesor medio de la CFNR. La OCT podría ser una técnica útil para medir esta degeneración neuronal.

Abstract: Vision problems are common in patients with diabetes mellitus (DM) because they may suffer from diabetic retinopathy (DR). Because the symptoms of this condition are not easy to detect without the intervention of an expert technician, the use of convolutional neural networks (CNN) has been implemented to speed up the process of analyzing retina images. Due to the good results of this technology, efforts have been made to combine it with other technologies. In this paper, we present the use of an intelligent hybrid system that uses CNNs and Fuzzy Logic with the aim of improving the accuracy obtained. The implementation of fuzzy logic to adjust the hyperparameters of the network allowed us to obtain a mean of 0.9526 with a standard deviation of 0.008521158 in the binary case study, while in the multiclass case study we obtained a mean of 0.7299 and a standard deviation of 0.015614013, offering better results when fuzzy logic is combined compared to when not.

Resumen La detección y el diagnóstico de diabetes e hipertensión presentan un escenario desafiante, principalmente en etapas tempranas. Estos dos son degenerativos y de graves consecuencias, provocando daños en múltiples órganos, incluidos los ojos. El oftalmólogo examina el fondo de la retina para discriminar el tipo de enfermedad. En el caso de la retinopatía, como enfermedad crónica, se evidencia en varias clases de progresión. La retinopatía diabética se clasifica en cuatro, que incluyen etapas leve, moderada, grave y proliferativa. En la etapa proliferativa, la retina produce factores vasoproliferativos que estimulan el crecimiento de nuevos vasos sanguíneos, aumentando el riesgo de pérdida de visión. En cuanto a la retinopatía hipertensiva, el método de clasificación más utilizado es la clasificación de Keith-Wagener-Barker. Similar a la retinopatía diabética, también consta de cuatro clases, que van de leves a graves. En la etapa grave, existe un mayor riesgo de desarrollar papiledema o edema retiniano. El objetivo principal de esta investigación es realizar la segmentación y clasificación de imágenes de fondo de retina con retinopatía diabética e hipertensiva. Se propuso una combinación de una red convolucional UNet y una ConvNet para la segmentación de máscara de vasos y la clasificación de retinopatía, respectivamente. El proceso de clasificación se basa en diez clases definidas, donde los valores que van del 0 al 4 representan la retinopatía diabética y los valores del 5 al 9 corresponden a la retinopatía hipertensiva. Los resultados aproximados en la segmentación fueron índices Jaccard de 74%, F1 de 85% y un Accuracy de 96%, y en la clasificación un Accuracy de 80%.

Abstract The detection and diagnosis of diabetes and hypertension present a challenging scenario, mainly in the early stages. These two are degenerative and with severe consequences, causing damage to multiple organs, including the eyes. The ophthalmologist examines the retinal fundus to discriminate between the type of disease. In the case of retinopathy, as a chronic disease, evidence in various classes of progression. Diabetic retinopathy is categorized into four, which include mild, moderate, severe, and proliferative stages. In the proliferative stage, the retina produces vasoproliferative factors that stimulate the growth of new blood vessels, increasing the risk of vision loss. As for the hypertensive retinopathy the most widely used method for classifying is the Keith-Wagener-Barker classification. Like diabetic retinopathy, it consists also of four classes, ranging from mild to severe. In the severe stage, there is an increased risk of developing papilledema or retinal edema. The main objective of this research is to perform segmentation and classification of diabetes and hypertensive retinopathy retinal fundus images. Using a combination of a convolutional network UNet and a ConvNet was proposed for vessel mask segmentation and retinopathy classification, respectively. The classification process relies on ten defined classes, where values ranging from 0 to 4 represent diabetic retinopathy, and values ranging from 5 to 9 correspond to hypertensive retinopathy. The approximate results in the segmentation were Jaccard index of 74%, F1 of 85%, and an Accuracy of 96%, and in the classification was Accuracy of 80%.

RESUMEN Introducción: Se reconoce la asociación entre los factores de riesgo aterogénico y las alteraciones microvasculares de la retina, pero no hay consenso sobre si estas afectaciones en la retina preceden o son una respuesta fisiopatológica a dichos factores. Objetivo: Determinar si la presencia de los factores de riesgo aterogénico predice las alteraciones vasculares retinianas, a través del fondo de ojo y la retinografía. Métodos: Estudio trasversal en 55 sujetos mayores de 19 años de edad, de cualquier sexo, sin opacidades en los medios transparentes del ojo. Se estudiaron las variables edad, sexo, dislipidemia, hábito de fumar, consumo de alcohol, hipertensión arterial, diabetes mellitus tipo 2, presión arterial sistólica y diastólica, índice de masa corporal, colesterol, glicemia, triglicéridos, creatinina, lipoproteínas de alta densidad, urea, eritrosedimentación y conteo leucocitario. Resultados: El 65,45 % presentó alteraciones en el fondo de ojo: aumento del brillo arteriolar (53,03 %) y disminución del calibre arteriolar generalizado (52,24 %). La retinografía mostró daño en el 58,18 %: rectificación de los cruces arteriovenosos (65,71 %), tortuosidad venosa (28,21 %) y cruces arteriovenosos con aplastamiento (85,71 %). El aumento del colesterol sérico (p= 0,003) se asoció con la presión arterial sistólica (p= 0,037) en el fondo de ojo, y con el antecedente de hipertensión arterial (p= 0,023) en la retinografía. Conclusiones: El colesterol sérico, las cifras elevadas de tensión arterial sistólica y antecedentes de hipertensión arterial son los factores de riesgo que mejor predicen el daño vascular retinal.

ABSTRACT Introduction: The association between atherogenic risk factors and retinal microvascular alterations is recognized, but there is no consensus on whether these retinal disorders precede or are a pathophysiological response to these factors. Objective: To determine if the presence of atherogenic risk factors predicts retinal vascular alterations, through fundus examination and retinography. Methods: Cross-sectional study in 55 subjects over 19 years of age, of either sex, without opacities in the transparent media of the eye. The variables studied were age, sex, dyslipidemia, smoking habit, alcohol consumption, arterial hypertension, type 2 diabetes mellitus, systolic and diastolic blood pressure, body mass index, cholesterol, glycemia, triglycerides, creatinine, high-density lipoproteins, urea, erythrocyte sedimentation rate and leukocyte count. Results: 65.45% presented alterations in the fundus of the eye: increased arteriolar brightness (53.03%) and decreased generalized arteriolar caliber (52.24%). Retinography showed damage in 58.18%: rectification of arteriovenous crossings (65.71%), venous tortuosity (28.21%), and arteriovenous crossings with crushing (85.71%). The increase in serum cholesterol (p= 0.003) was associated with systolic blood pressure (p= 0.037) in the fundus, and with a history of arterial hypertension (p= 0.023) in retinography. Conclusions: Serum cholesterol, high systolic blood pressure and a history of hypertension are the risk factors that best predict retinal vascular damage.

Resumen Se presentan técnicas de segmentación de vasos sanguíneos en imágenes de la retina. Estos métodos se pueden utilizar en análisis informáticos de imágenes retinales y en la detección semiautomática y automática de los vasos. Se tratará el método basado en la extracción de crestas de imágenes, que coinciden aproximadamente con las líneas centrales de los vasos, las crestas son utilizadas para componer elementos primitivos en forma de línea. Los métodos semiautomáticos disminuyen la demora en el análisis de las imágenes, frente a los métodos tradicionales manuales y contribuyen a una mejor calidad en las bases de datos.

Abstract Blood vessel segmentation techniques in retinal images are presented. These methods can be used in computational analysis of retinal images and in semiautomatic and automatic detection of vessels. The method based on the extraction of image ridges will be discussed, which approximately coincide with the central lines of the vessels, the ridges are used to compose primitive line-shaped elements. Semiautomatic methods reduce the delay in image analysis, compared to traditional manual methods, and contribute to better quality in the databases.

RESUMEN Introducción: La córnea constituye el elemento más importante del sistema óptico, al ser el primer medio transparente del ojo; tiene la finalidad de mejorar la calidad de la imagen que se forma en la retina, por lo que su transparencia es imprescindible para poder obtener una buena agudeza visual. Cuando sus capas están afectadas por diferentes enfermedades, se requiere sustituir este tejido dañado; este procedimiento, denominado trasplante de córnea o queratoplastia, tiene diferentes finalidades. Objetivo: Caracterizar los resultados de la cirugía de trasplante de córnea tras diez años del primer procedimiento quirúrgico en la provincia de Villa Clara. Métodos: Se realizó un estudio observacional descriptivo longitudinal retrospectivo, con una muestra de 204 pacientes operados de trasplante de córnea en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» de Villa Clara, en el período comprendido entre 2008 y 2018. Las variables estudiadas fueron: sexo, finalidad del procedimiento, diagnóstico y complicaciones. Resultados: Predominó el sexo masculino (53,4 %); la finalidad más frecuente del trasplante tuvo fines ópticos (85,8 %); principal diagnóstico: la queratopatía bullosa (42,7 %); dentro de las complicaciones más frecuentes estuvieron: el rechazo al injerto, el defecto epitelial y el glaucoma secundario. Conclusiones: La cirugía de trasplante de córnea en la provincia de Villa Clara significa un gran avance en el desarrollo y perfeccionamiento para el tratamiento de múltiples afecciones corneales. Los diagnósticos más frecuentes fueron: la queratopatía bullosa y las opacidades corneales; las complicaciones más frecuentes, el rechazo al injerto, la aparición de defectos epiteliales y el glaucoma secundario.

ABSTRACT Introduction: the cornea constitutes the most important element of the optical system, being the first transparent medium of the eye; its purpose is to improve the quality of the image that is formed on the retina, so its transparency is essential to obtain good visual acuity. When its layers are affected by different diseases, it is required to replace this damaged tissue; this procedure called cornea transplant or keratoplasty has different purposes. Objective: to characterize the results of corneal transplant surgery ten years after the first surgical procedure in Villa Clara province. Methods: a retrospective, longitudinal, descriptive and observational study was carried out with a sample of 204 patients who underwent corneal transplant surgery at "Arnaldo Milián Castro" Clinical and Surgical University Hospital in Villa Clara between 2008 and 2018. Age, purpose of the procedure, diagnosis and complications were the variables studied. Results: male gender predominated (53.4%); the most frequent purpose of the transplant was for optical purposes (85.8%); bullous keratopathy (42.7%) was the main diagnosis as well as, graft rejection, epithelial defect and secondary glaucoma were among the most frequent complications. Conclusions: corneal transplant surgery in Villa Clara province means a great advance in the development and improvement for the treatment of multiple corneal conditions. The most frequent diagnoses were bullous keratopathy and corneal opacities; graft rejection, the appearance of epithelial defects and secondary glaucoma were the most frequent complications.

RESUMEN Introducción: La oclusión de la arteria central de la retina o de alguna de sus ramas constituye un accidente vascular agudo que amenaza la visión del paciente. Esta es la causa más frecuente de pérdida brusca e indolora de la visión. Objetivo: Presentar un caso de oclusión de la arteria central de la retina diagnosticado mediante ultrasonido Doppler. Métodos: Se consideró una combinación de métodos clínicos e imagenológicos. Presentación del caso: Se presenta un paciente masculino, de raza blanca y 55 años que acudió a Consulta Externa del Servicio De Oftalmología del Hospital Clínico Quirúrgico “Lucia Iñiguez Landín”, de Holguín. Refirió pérdida visual súbita en el ojo izquierdo, motivo por el cual fue tratado mediante ultrasonido Doppler y puesto bajo seguimiento. Conclusiones: Un acertado enfoque diagnóstico ha sido siempre un reto intelectual fascinante para los médicos, y una fuente inagotable de satisfacciones en su vida profesional, siempre y cuando se dominen sus bases y procedimientos, sirva esto como singularidad y novedad de la obra que se presenta.

ABSTRACT Introduction: Occlusion of the central retinal artery or any of its branches is an acute vascular accident that threatens the patient's vision. This is the most frequent cause of sudden and painless loss of vision. Objective: To present a case of central retinal artery occlusion diagnosed by Doppler ultrasound. Methods: A combination of clinical and imaging methods was considered. Case presentation: The case is presented of a 55-year-old white male patient, who attended the outpatient department of the ophthalmology service at Hospital Clínico Quirúrgico Lucia Íñiguez Landín, in Holguín. He reported sudden loss of vision in the left eye, for which he was treated by Doppler ultrasound and received follow-up. Conclusions: An accurate diagnostic approach has always been a fascinating intellectual challenge for physicians, as well as an inexhaustible source of satisfactions in their professional life, as long as its bases and procedures are mastered; let this serve as singularity and novelty of the presented work.

ABSTRACT Rhegmatogenous retinal detachment is a disease with an associated potential threat to visual function, which requires surgical treatment as soon as possible. Pneumatic retinopexy is a minimally invasive surgical procedure useful for repairing uncomplicated rhegmatogenous retinal detachments with specific selection criteria. We present a patient diagnosed with uncomplicated rhegmatogenous retinal detachment at the Arnaldo Milián Castro Hospital, who was operated with pneumatic retinopexy technique without traditional selection criteria, with good anatomical and functional results. Extending the selection criteria to solve uncomplicated rhegmatogenous retinal detachment without traditional criteria for pneumatic retinopexy may be an excellent option provided it is performed objectively, reasonably and tailored to each case.

RESUMEN El desprendimiento regmatógeno de retina es una enfermedad con un potencial asociado de amenaza a la función visual, el cual requiere de un tratamiento quirúrgico tan pronto como sea posible. La retinopexia neumática es un proceder quirúrgico mínimamente invasivo útil para reparar desprendimientos regmatógenos de retina no complicados con criterios de selección específicos. Se presenta a un paciente diagnosticado con desprendimiento regmatógeno de retina no complicado en el Hospital Arnaldo Milián Castro, que fue operado con técnica de retinopexia neumática sin los criterios tradicionales de selección, con buen resultado anatómico y funcional. Extender los criterios de selección para solucionar desprendimientos regmatógenos de retina no complicados sin criterios tradicionales para retinopexia neumática puede ser una excelente opción siempre que se realice de forma objetiva, razonable y entallada a cada caso.

People living with HIV (PLWH) may face an increased risk of eye complications associated with ageing, chronic inflammation, and the toxicity arising from long-term antiretroviral therapy (ART). This review aims to understand how inflammatory pathways contribute to retinal alterations observed in PLWH on long-term ART. This review was conducted using four electronic database searches, namely Scopus, Hinari, Google Scholar, and PubMed; from 1996 (when ART became available) until January 2022, without language restriction. Sources from clinical trials, meta-analyses, randomised controlled trials, and systematic reviews were used. Dysregulated para-inflammation (chronic inflammation) damages the blood-retina barrier, resulting in the altered retinal immune privilege and leading to the development of retinal and blood vessel changes. There is an interplay between the effects of the disease versus ART. ART causes mitochondrial toxicity, which affects the retinal ganglion cells and retinal pigment epithelium (RPE) due to oxidative stress. Infection by HIV also affects retinal microglia, which contributes to RPE damage. Both of these mechanisms affect the blood vessels. Assessing the integrity of the inner and outer blood-retina barrier is a pivotal point in pinpointing the pathogenesis of inner retinal alterations. Optical coherence tomography is a valuable tool to assess these changes. There is a paucity of research to understand how these structural changes may affect visual function, such as contrast sensitivity and colour vision.

BACKGROUND: Understanding the relationship between biometric and structural changes in childhood myopia is necessary to effectively manage myopia progression AIM: To determine the relationship between ocular biometry, fovea and sub-fovea choroidal thickness in school-aged children with myopia of Nigerian descent SETTING: Abuja, Nigeria METHODS: This study involved 189 children (117 girls and 72 boys), and myopia was defined as cycloplegic spherical equivalent refraction (SER) of ≤ −0.50 D. Keratometry values, biometry data, fovea and sub-foveal choroidal thickness (SFChT) values were obtained from medical records retrospectively and analysed RESULTS: The median age was 13 years (interquartile range [IQR]: 5). The median SER, fovea and SFChTs were −2.63 D (IQR: 3.38), 249 μm (IQR: 118) and 225 μm (IQR: 341), respectively. Male children had flatter corneas, thicker fovea and thinner SFChT compared to female children. The vitreous chamber and axial length were longer and sub-fovea choroid was thinner in children with high myopia. There was a weak but significant positive correlation between myopia and sub-fovea choroidal thickness (r = 0.270 respectively, P < 0.01). A moderate negative correlation was found between myopia and vitreous chamber depth (r = −0.536, P < 0.001), and a strong negative correlation was found between myopia and axial length (r = −0.706, P < 0.001 CONCLUSION: Myopia in school-aged Nigerian children is associated with sub-fovea choroidal thinning, increased vitreous chamber depth and axial elongation CONTRIBUTION: This study provides data on the relationship between ocular biometry, fovea and sub-foveal choroidal thickness in school-aged Nigerian children with myopia

RESUMO O presente relato de caso identificou a maculopatia média aguda paracentral como a causa de baixa de acuidade visual severa e irreversível após cirurgia de catarata. Existem fatores de risco bem estabelecidos para o desenvolvimento da maculopatia média aguda paracentral que devem ser conhecidos pelos cirurgiões de catarata. Nesse contexto cirúrgico, precauções extras no tocante a procedimentos anestésicos, pressão intraocular e alguns outros aspectos da cirurgia devem ser consideradas. A maculopatia média aguda paracentral é descrita como um sinal clínico observado no exame de tomografia de coerência óptica por domínio espectral e se trata, provavelmente, da evidência de um evento isquêmico no tecido vascular retiniano. Esse diagnóstico deve ser cogitado nos casos de perda de acuidade visual súbita no pós-operatório imediato associada com exame fundoscópico normal, como evidenciado no caso apresentado. catarata cirúrgico anestésicos consideradas trata provavelmente retiniano pósoperatório pós operatório normal apresentado

ABSTRACT This case report identified paracentral acute middle maculopathy as the cause of severe and irreversible vision loss after cataract surgery. Cataract surgeons should be aware of known risk factors for the development of paracentral acute middle maculopathy. In those patients, extra care regarding anesthesia, intraocular pressure, and some other aspects of cataract surgery must be taken. Paracentral acute middle maculopathy is currently understood as a clinical sign evident on spectral-domain optical coherence tomography, and it is probably evidence of deep ischemic insult to the retina. It should be a differential diagnosis in cases of marked low vision acuity associated with no fundus abnormalities in the immediate postoperative period, as demonstrated in the presented case. patients anesthesia pressure taken spectraldomain spectral domain tomography retina period

RESUMO Objetivo: Determinar as taxas de fechamento de buracos maculares idiopáticos grandes tratados com vitrectomia posterior e técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça pós-operatório e definir melhora visual, tipos de fechamento do buraco macular e integridade das camadas retinianas externas como objetivo secundário. Métodos: Este estudo foi uma série retrospectiva de casos. Todos os pacientes foram submetidos a vitrectomia com flap invertido 360 graus pediculado de membrana limitante interna e tamponamento com gás, sem posição de cabeça no pós-operatório. Idade, gênero, tempo de redução da acuidade visual, outras patologias oculares e status do cristalino foram compilados. Medida de melhor acuidade visual corrigida e tomografia de coerência óptica foram registradas durante as visitas de pré e pós-operatório (15 dias e 2 meses após cirurgia). Resultados: Vinte olhos de 19 pacientes foram incluídos neste estudo. A idade média foi de sessenta e seis anos. Um total de 19 olhos (95%) atingiu fechamento do buraco, observado através das imagens de tomografia de coerência óptica após 2 meses de cirurgia. Melhor acuidade visual corrigida média aumentou +1,08 pré-operatória para +0,66 LogMAR em 2 meses de cirurgia (p<0,001), com média de 20 letras de melhora visual (0,4 LogMAR) na tabela do Early Treatment Diabetic Retinopathy Study. Dois tipos de fechamento do buraco foram observados: V (47,36%) e U (52,63%). Conclusão: A técnica de flap invertido 360 graus pediculado de membrana limitante interna, sem posicionamento de cabeça no pós-operatório promoveu elevada taxa de fechamento (95%), reestabelecimento das camadas retinianas externas, fechamento com contorno foveal dos tipos V e U, além de melhora visual na maioria dos casos de BMI gran des (mesmo nos buracos maiores que 650 μm). Esta técnica pode representar uma alternativa para o tratamento de buracos maculares grandes em pacientes impossibilitados de cumprir o tradicional posicionamento de cabeça pós-operatório. Objetivo 36 pósoperatório pós operatório secundário Métodos gás pósoperatório. operatório. Idade gênero compilados 15 (1 . cirurgia) Resultados 1 anos 95% 95 (95% 108 08 +1,0 préoperatória operatória 066 0 66 +0,6 p<0,001, p0001 p p<0,001 , 001 (p<0,001) 0,4 04 4 (0, Study observados 47,36% 4736 47 (47,36% 52,63%. 5263 52,63% 52 63 (52,63%) Conclusão 95%, mesmo 65 μm. μm μm) 3 ( 9 (95 10 +1, 06 6 +0, p000 p<0,00 00 (p<0,001 0, (0 47,36 473 (47,36 526 52,63 5 (52,63% (9 +1 +0 p00 p<0,0 (p<0,00 47,3 (47,3 52,6 (52,63 + p0 p<0, (p<0,0 47, (47, 52, (52,6 p<0 (p<0, (47 (52, p< (p<0 (4 (52 (p< (5 (p

ABSTRACT Purpose: This study aimed to determine closure rates of large idiopathic macular holes treated with pars plana vitrectomy and 360-degree pedicled inverted internal limiting membrane flap without face-down posturing and define visual improvement, types of macular hole closure, and external retina integrity as secondary outcomes. Methods: This retrospective case series analyzed all patients who were treated by vitrectomy, 360-degree pedicled inverted internal limiting membrane flap, and gas tamponade, without face-down posturing postoperatively. Age, sex, time of visual acuity reduction, other ocular pathologies, and lens status were collected. The best-corrected visual acuity and optical coherence tomography results were recorded during pre- and postoperative follow-up examinations (15 days and 2 months after surgery). Results: This study enrolled 20 eyes of 19 patients, and the mean age was 66 years. Optical coherence tomography performed 2 months after surgery revealed hole closure in 19 (95%) eyes. The median best-corrected visual acuity improved from +1.08 preoperatively to +0.66 LogMAR 2 months postoperatively (p<0.001), with a median of 20 letters of visual improvement (0.4 LogMAR) on the Early Treatment Diabetic Retinopathy Study chart. V (47.36%)- and U (52.63%)-types of closure were observed. Conclusion: The 360-degree pedicled inverted internal limiting membrane flap technique, without face-down posturing, provided a high closure rate (95%), external layer recovery, and V- and U-type foveal closure contours, in addition to visual improvement in most cases of large macular holes (even macular holes >650 μm). This technique may be a viable alternative to patients in whom traditional postoperative face-down positioning for large macular hole treatment is not possible. Purpose 360degree degree 360 facedown face down outcomes Methods tamponade Age sex reduction pathologies collected bestcorrected best corrected pre followup follow up 15 (1 surgery. . surgery) Results 1 6 years 95% 95 (95% 108 08 +1.0 066 0 +0.6 p<0.001, p0001 p p<0.001 , 001 (p<0.001) 0.4 04 4 (0. chart 47.36% 4736 47 36 (47.36%) 52.63%types 5263types 52.63% 52 63 observed Conclusion 95%, recovery Utype type contours even 650 >65 μm. μm μm) possible ( 9 (95 10 +1. 06 +0. p000 p<0.00 00 (p<0.001 0. (0 47.36 473 3 (47.36% 5263 52.63 5 65 >6 (9 +1 +0 p00 p<0.0 (p<0.00 47.3 (47.36 526 52.6 > + p0 p<0. (p<0.0 47. (47.3 52. p<0 (p<0. (47. p< (p<0 (47 (p< (4 (p