SIGNIFICANCE The clinical manifestations of ocular syphilis may mimic those of other diseases, which may result in a missed diagnosis and delayed treatment. PURPOSE We describe multimodal imaging findings and treatment outcomes of a patient with chronic syphilitic chorioretinitis. CASE REPORT A 40-year-old male patient complained of progressive decreased visual acuity of his left eye for more than 1 year. The best-corrected visual acuity was 20/20 in the right eye and 3/50 in the left eye. Relative afferent pupillary defect and 1+ vitreous cells were detected in the left eye. The authors performed fundus examination, fluorescence angiography, ultrawide-field fundus autofluorescence, structure optical coherence tomography, wide-field montage optical coherence tomography angiography, and visual field. Laboratory tests including a toluidine red unheated serum test (1:32) and the Treponema pallidum antibody (9.01S/CO) showed positive results. Chronic syphilitic chorioretinitis was diagnosed in both eyes. The patient was admitted for administration of intravenous penicillin G for 14 days, followed by intramuscular benzathine penicillin G weekly for three doses. Six months after treatment, the toluidine red unheated serum test ratio had decreased to 1:2 (positive). The best-corrected visual acuity was 20/20 in the right eye and 6/20 in the left eye. The reexamination results showed that the ocular structure and capillaris flow partially recovered. CONCLUSIONS Chronic syphilitic chorioretinitis profoundly affects the structure of the retina and choroid; however, eyes may partially recover after an effective treatment. Ultrawide-field imaging technology has several advantages, such as broader imaging field and more details provided, in determining syphilis-induced ocular disorders.

Case Report: Multimode Imaging of Chronic Syphilitic Chorioretinitis

En este artículo haremos un breve recorrido por el uso, la terminología y los recursos disponibles en el campo de la salud digital (centrado en la telemedicina y las videoconsultas) y cómo podemos abordar la incorporación de la competencia digital en la formación de los residentes a través de una aproximación organizada. In this article we will take a brief tour of the use, terminology and resources available in the field of digital health (focused on telemedicine and video consultations) and how we can approach the incorporation of digital competence in the training of residents through of an organized approach. 

Nuevos retos en la formación sanitaria especializada relacionados con competencias en telemedicina y tecnologías de la información y comunicación

Recent advancements in teleophthalmology have transformed retinal disease management, benefiting healthcare providers and patients. By enabling remote monitoring, teleophthalmology significantly reduces the need for in-person consultations. Easy-to-use devices like at-home Optical Coherence Tomography (OCT) systems empower patients to generate high-quality images crucial for tailored treatment. Artificial intelligence (AI) aids in quick, affordable screenings by analysing fundus photographs and OCT images. These innovations underscore teleophthalmology’s pivotal role in streamlining patient care and optimising healthcare resources. Legal, ethical, and logistical considerations surrounding teleophthalmology, drawn from literature and experiences at Bristol Eye Hospital, are also discussed. 

pdf/teleophthalmology-in-retinal-diseases-22o7yjlqtz.pdf

Teleophthalmology in retinal diseases

The accurate documentation of a medical history interview is an important goal in medical education. As students' documentation of medical history interviews is mostly decentralised on the wards, a systematic assessment of documentation quality is missing. We therefore evaluated the extent of details missed in students' medical history reports in a standardised setting.In this prospective, observational study, 123 of 380 students (32.4%) participated in an Objective Structured Clinical Examination (OSCE) regarding history taking and documentation. Based on the interviews and nine deductively selected main categories, a categorical system was established using a summarising qualitative content analysis. The items in the transcripts (defined as ground truth) and in students' reports were labelled and assigned to the correct subcategory. The ground truth and students' reports were compared to quantify students' documentation completeness.Next to the nine deductively selected main categories, 61 subcategories were defined. A total of 8943 items were labelled in the 123 interview transcripts (ground truth), compared with 5870 items labelled in students' reports (65.6% completeness of students' reports compared with ground truth). The main category personal details overlapped with 94.2% between students' report and ground truth in contrast to the main category with the highest discrepancy, allergy, with 41.1% overlap. Pertinent negative items and non-numerical quantifications were often missed.Medical students show incomplete documentation of medical history interviews. Therefore, accurate documentation should be taught as an important goal in medical education. 

Lost in translation: Unveiling medical students' untold errors of medical history documentation

Purpose of review The growing push to integrate telemedicine into ophthalmic practices requires physicians to have a thorough understanding of ophthalmic telemedicine's applications, limitations, and recent advances in order to provide well tolerated and appropriate clinical care. This review aims to provide an overview of recent advancements in the use of ophthalmic telemedicine for anterior segment eye examinations. Recent findings Virtual care for anterior segment evaluation relies on appropriate technology, novel workflows, and appropriate clinical case selection. Recent advances, particularly in the wake of the COVID-19 pandemic, have highlighted the utility of home-based assessments for visual acuity, external evaluation, tonometry, and refraction. Additionally, innovative workflows incorporating office-based testing into virtual care, termed ‘hybrid telemedicine’, enable high-quality ophthalmic testing to inform clinical decision-making. Summary Novel digital tools and workflows enable high-quality anterior segment evaluation and management for select ophthalmic concerns. This review highlights the clinical tools and workflows necessary to enable anterior segment telehealth. 

Implementation of anterior segment ophthalmic telemedicine

Background  The COVID-19 pandemic has accelerated the adoption of telemedicine in the field of ophthalmology. Despite the increasing utilization of telemedicine, there is a lack of formal training in ophthalmology residency programs to ensure ophthalmologists are prepared to conduct virtual eye exams. Objective  This article aims to assess the impact of an ophthalmic telemedicine curriculum on ophthalmology residents' self-reported knowledge acquisition in conducting telemedicine eye exams, perceived ability to diagnose, manage, and triage common eye diseases, and evaluate their attitudes toward the current and future use of teleophthalmology. Methods  This single-center study at Massachusetts Eye and Ear used a nonvalidated pre- and postcurriculum survey conducted during the 2020 to 2021 academic year among ophthalmology residents. Participants engaged in an ophthalmic telemedicine curriculum that consisted of interactive didactic lectures and electronic postdidactic assessments. Results  Twenty-four residents (100%) completed a precurriculum survey, while 23 of 24 (95.8%) residents completed both the telemedicine curriculum and a postcurriculum survey. On a five-point Likert scale, the median interquartile range (IQR) scores for confidence with setup/logistics, history taking, examination, documentation, and education increased from 2.5 (2.0–4.0) to 4.0 (3.5–4.5) ( p  = 0.001), 3.0 (3.0–4.0) to 5.0 (4.0–5.0) ( p  < 0.001), 2.0 (1.8–2.0) to 4.0 (3.5–4.0) ( p  < 0.001), 2.0 (1.0–2.0) to 4.0 (3.0–4.0) ( p  < 0.001), and 2.5 (2.0–3.0) to 4.0 (4.0–4.0) ( p  < 0.001), respectively. The median (IQR) scores for comfort with ethics/professionalism, disparities and conducting patient triage, diagnosis, and management increased from 2.0 (2.0–2.3) to 4.0 (3.0–4.0) ( p  < 0.001), 2.0 (2.0–2.0) to 3.0 (3.0–4.0) ( p  < 0.001) and 3.0 (2.0–3.0) to 4.0 (3.0–4.0) ( p  = 0.001), 2.0 (2.0–3.0) to 3.0 (3.0–4.0) ( p  < 0.001), and 3.0 (2.0–3.0) to 3.0 (3.0–4.0) ( p  = 0.008), respectively. Conclusion  The implementation of an ophthalmic telemedicine curriculum increased resident confidence and self-reported knowledge across all logistical and clinical components of virtual ophthalmic care. Formal telehealth curricula can address an unmet educational need of resident trainees in an era of rapid uptake and utilization of telehealth services.

/pdf/telemedicine-curriculum-in-an-ophthalmology-residency-h1x1x3og.pdf

Telemedicine Curriculum in an Ophthalmology Residency Program

https://doi.org/10.1016/j.ajoc.2022.101695

Acute syphilitic posterior placoid chorioretinitis as the presenting symptom of syphilis in an immunocompetent patient

To identify clinical characteristics of injured eyes associated with visual recovery in patients with open globe injuries (OGI) and presenting with no light perception (NLP) vision. Retrospective chart review. All patients presenting to Massachusetts Eye and Ear with OGI and NLP vision from January 1999 to March 2022. Manual data extraction to collect patient demographic characteristics, pre-operative, intraoperative, and post-operative characteristics of OGI injury, laceration versus rupture, history of intraocular surgery, time from injury to repair, timing of vitrectomy, lensectomy, choroidal drainage, and silicone oil placement, visual acuity (VA) at last follow-up, and subsequent B-scan ultrasound findings of retinal detachment, choroidal hemorrhage, vitreous hemorrhage, and disorganized intraocular contents. Patients with more than one week of follow-up and a documented VA at most recent follow-up were included. Exclusion criteria included age less than 10 years. Multivariable regression was performed. VA recovery defined as light perception or better in patients with OGI and initial NLP vision. 147 eyes with NLP vision after OGI were included. 25 (17%) eyes regained vision at last follow-up. The majority of patients recovered light perception vision (n=15, 60%) followed by 20/500 or better (n=5, 20%), hand motion (n=3, 12%), and count fingers (n=2, 8%). Most injuries were zone III (n=102, 69%) and presented with rupture (n=127, 86%). The mean time from OGI to surgical repair was 0.85 ± 1.7 days. B-scan was obtained in 104 (71%) cases. Pars plana vitrectomy was performed in 9 eyes (6%) with NLP at time of vitrectomy. Disorganized intraocular contents on B-scan (OR=0.170, 95%CI: 0.042-0.681, P=0.012) was the only clinical variable significantly associated with visual recovery, corresponding to a lack of visual improvement. Recovery of vision in OGI with NLP vision at presentation cannot be predicted based on presenting clinical features. B-scan findings of disorganized intraocular contents after initial OGI repair was the only factor negatively associated with vision recovery in this patient population. Therefore, all eyes presenting with an OGI and NLP vision should undergo primary repair in hopes of subsequent visual recovery. 

Recovery of Vision in Open Globe Injury Patients with Initial No Light Perception Vision.

PURPOSE
To report a case of bilateral exudative retinal detachments and panuveitis in a patient with multiple myeloma (MM).


CASE REPORT
A 54-year-old patient with non-proliferative diabetic retinopathy was referred with blurred vision and scotomas in both eyes (OU). Three months prior to the onset of ocular symptoms, he was diagnosed with systemic MM and was receiving chemotherapy. Clinical examination revealed best-corrected visual acuities of 20/80 OU, rare anterior chamber cell, 2+ vitreous cell, diffuse intraretinal hemorrhages, and exudative retinal detachments (RD). Optical coherence tomography of the macula showed central subretinal fluid with cystic intraretinal fluid OU. The findings were consistent with panuveitis and exudative RD in the setting of MM. He reported symptomatic improvement after plasmapheresis and oral prednisone initiation.


CONCLUSION
Extensive, bilateral exudative RD and panuveitis are rare but potentially sight-threatening findings in patients with MM.

Bilateral Exudative Retinal Detachments and Panuveitis in a Patient with Multiple Myeloma.

Supplemental Digital Content is Available in the Text. Purpose: The purpose of this study was to report a case of corneal transparency for 7 months after the formation and persistence of a Descemet fluid cleft. Methods: We report the case of a 64-year-old woman undergoing anterior chamber reformation 2 months after Baerveldt implantation of the right eye. During the procedure, the ophthalmic viscoelastic was inadvertently injected into the posterior stroma, nearly isolating the corneal endothelial cell layer, and creating a Descemet fluid cleft filled with viscoelastic. The patient was managed conservatively and monitored near monthly for corneal decompensation. Results: The cornea remained centrally clear for 207 days after the initial anterior chamber reformation until the collapse of the viscoelastic cleft. When the cleft completely collapsed, the cornea became diffusely edematous, and the patient underwent cataract removal and intraocular lens placement without need for Descemet stripping endothelial keratoplasty to maintain vision. During these 7 months, the patient's best-corrected visual acuity remained stable at 20/25+2 or better. Intraocular pressure was also stable, averaging 18.2 mm Hg. Conclusions: We hypothesize that corneal transparency can be maintained in the absence of endothelial cell function provided that aqueous humor cannot reach the cornea and disrupt the arrangement of the interfibrillar space.

Unintentional Descemet Cleft Introduces Novel Mechanism of Maintenance of Corneal Clarity

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