Severe Visual Acuity Loss Research Articles

Clinical and Molecular Characterization of PROM1-Related Retinal Degeneration

The PROM1 gene, commonly associated with cone-rod dystrophies, may have dominant or recessive phenotypes that influence disease onset and severity. To characterize the clinical phenotype and molecular genetic variations in patients with PROM1 variants. This case-series study was conducted at 2 specialist retinal genetics clinics and examined 19 consecutively enrolled patients with PROM1-related retinal degeneration. Data were collected and analyzed from May 2018 to December 2018. Results of ophthalmic examination, retinal imaging, and molecular genetic analysis by next-generation sequencing. Of 19 patients, 13 (68%) were women, and age ranged from 11 to 70 years. All patients presented with central visual loss, with or without photophobia. Individuals with recessive variants commonly had severe loss of visual acuity by their 20s, whereas the dominant variant was associated with a milder phenotype, with most patients retaining good vision into late adulthood. The recessive cases were associated with a panretinal dystrophy of cone-rod phenotype with early macular involvement, whereas the dominant variants were associated with a cone-rod phenotype that was restricted to the macula with predominantly cone dysfunction. Next-generation sequencing identified 3 novel and 9 previously reported variants in PROM1. Recessive mutations included 6 truncating variants (3 nonsense and 3 frameshift), 4 splice site variants, and 1 missense variant. All 6 dominant variants were associated with a c.1117C>T missense variant. The variants were distributed throughout the PROM1 genomic sequence with no specific clustering on protein domains. In this case-series study, PROM1 recessive variants were associated with early-onset, severe panretinal degeneration. The similar phenotypes observed in patients with homozygous missense variants and splice site variants compared with similarly aged patients with truncating variants suggests that all recessive variants have a null (or loss of function close to null) outcome on PROM1 function. In contrast, the dominant missense cases were associated with a milder, cone-driven phenotype, suggesting that the dominant disease is preferentially associated with cones. This has implications for the development of treatments for this severely blinding disease, and adeno-associated viral vector-based gene therapy and optogenetics could become successful treatment options.

Early administration of adalimumab for paediatric uveitis due to Beh\xe7et\u2019s disease

BackgroundBehçet’s disease is a chronic inflammatory multisystem disorder that is characterised by oral and/or genital ulcerations as well as intraocular inflammation. Recurrent retinal vasoocclusive episodes and macular involvement may lead to severe loss of visual acuity. Patients may eventually become resistant to systemic corticosteroid and develop side effects; therefore, other immunosuppressive therapies are needed. Biologic agents are promising for the treatment of Behçet’s disease-associated uveitis. Here, we report two cases of paediatric uveitis due to Behçet’s disease that were successfully treated by early administration of adalimumab.Case presentationPatient 1 was an 11-year-old girl who presented with right conjunctival injection and photophobia. Patient 2 was a 14-year-old girl who presented with blurry vision in the left eye. Both patients were treated with topical treatment and prednisolone for uveitis; however, relapses occurred during the tapering of prednisolone. The patients were diagnosed with Behçet’s disease, and adalimumab therapy was initiated. In both cases, the inflammation was well-controlled by adalimumab administration without local or systemic corticosteroid.ConclusionsAdalimumab is effective for treating children with Behçet’s disease-associated uveitis. Control of ocular inflammation was achieved without local and systemic corticosteroid, thus preventing further complications.

Haze and Visual Acuity Loss After Sequential Photorefractive Keratectomy and Corneal Cross-linking for Keratoconus.

To investigate the results after photorefractive keratectomy (PRK) followed immediately by standard 30-minute corneal cross-linking (CXL) for keratoconus. This retrospective study included 26 eyes of 16 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (SE) and cylinder, apical keratometry, corneal higher order aberrations (HOAs), and corneal haze were evaluated. Mean follow-up was 32 ± 8 months (range: 19 to 50 months) and mean patient age was 31 ± 5 years (range: 24 to 40 years). Mean UDVA improved significantly from 0.80 ± 0.39 to 0.32 ± 0.36 logMAR after surgery (P < .001), but the mean CDVA worsened significantly from 0.07 ± 0.09 to 0.15 ± 0.14 logMAR after surgery (P = .006). Thirteen eyes (50%) lost at least one line of CDVA, 3 eyes (12%) lost two lines, and 4 eyes (15%) lost three lines. SE, cylinder, and apical keratometry decreased significantly. Corneal haze grade 1 was found in 15 eyes (57.7%), grade 2 in 6 eyes (23.1%), and grade 3 in 1 eye (3.8%). A significant correlation was seen between postoperative CDVA loss and corneal haze (P = .001) and history of atopy (P < .01), but not with corneal HOA change. Despite an improvement in UDVA and topographic values, the loss of CDVA, explained by postoperative haze, demonstrates that this procedure should be approached with caution, may not be as safe as initially thought, especially in patients with atopy and can cause severe visual acuity loss. [J Refract Surg. 2019;35(2):109-114.].

First Year Results of Subretinal Mesenchymal Stem Cell Implantation in Severe Retinitis Pigmentosa

This study includes one-year results of 14 patients with severe Retinitis Pigmentosa (RP) who had subretinal mesenchymal stem cell (ADMSC) implantation. The highest Visual Acuity (VA) in the study was 20/2000 and 7 of the patients had severe VA loss. The patients received subretinal ADMSCs after total vitrectomy. We observed no systemic complications. There were no ocular complications in 8 patients. Choroidal Neovascular Membrane (CNM) developed in one of the patients and intravitreal anti-VEGF injection was performed. The first six patients had Epiretinal Membrane (ERM) with peripheral tractional retinal detachment and received second vitrectomy. One of the patients experienced mild band keratopathy six months after the treatment and another patient had retrolental fibrous tissue at 1-year follow-up examination. Four patients showed VA gain during the first year. Subretinal implantation of ADMSCs may have some adverse effects and the patients should be followed up carefully. This study clarifies the side effects of the therapy which would enlighten future studies. Further studies with higher number of patients will be necessary to optimize the surgical procedure and to determine the benefits of this therapy.

Laser Treatment in Central Retinal Vein Occlusion and Macular Edema

Central retinal vein occlusion can result in severe visual acuity loss that is a common retinal vascular disorder. There are two distinct laser treatments: Grid and scatter pan-retinal photocoagulation. Grid laser aims to reduce macular edema and improve visual acuity. The aim of scattering pan-retinal photocoagulation to reduce VEGF burden by ablating peripheral ischemic retina and prevent the development of neovascularization in the retina, iris, and angle or to provide regression if developed. Laser photocoagulation is currently performed in combination with intravitreal anti-VEGF and intravitreal steroid treatments, but not alone in retinal vein occlusion.

Binocular Summation for Reflexive Eye Movements: A Potential Diagnostic Tool for Stereodeficiencies.

PurposeStereoscopic vision, by detecting interocular correlations, enhances depth perception. Stereodeficiencies often emerge during the first months of life, and left untreated can lead to severe loss of visual acuity in one eye and/or strabismus. Early treatment results in much better outcomes, yet diagnostic tests for infants are cumbersome and not widely available. We asked whether reflexive eye movements, which in principle can be recorded even in infants, can be used to identify stereodeficiencies.MethodsReflexive ocular following eye movements induced by fast drifting noise stimuli were recorded in 10 adult human participants (5 with normal stereoacuity, 5 stereodeficient). To manipulate interocular correlation, the stimuli shown to the two eyes were either identical, different, or had opposite contrast. Monocular presentations were also interleaved. The participants were asked to passively fixate the screen.ResultsIn the participants with normal stereoacuity, the responses to binocular identical stimuli were significantly larger than those induced by binocular opposite stimuli. In the stereodeficient participants the responses were indistinguishable. Despite the small size of ocular following responses, 40 trials, corresponding to less than 2 minutes of testing, were sufficient to reliably differentiate normal from stereodeficient participants.ConclusionsOcular-following eye movements, because of their reliance on cortical neurons sensitive to interocular correlations, are affected by stereodeficiencies. Because these eye movements can be recorded noninvasively and with minimal participant cooperation, they can potentially be measured even in infants and might thus provide an useful screening tool for this currently underserved population.

Acute Retinal Necrosis Multicenter Case Series: Prognostic Indicators and Treatment Outcomes

Purpose: The purpose of this article is to report the prognostic associations of acute retinal necrosis (ARN), determine the diagnostic utility of aqueous vs vitreous polymerase chain reaction (PCR), and describe outcomes of antiviral, corticosteroid, antithrombotic, and laser retinopexy treatment. Methods: A retrospective, nonrandomized case series was conducted. Primary outcomes included final visual acuity (VA), severe VA loss (≥1.00 log of the minimum angle of resolution [logMAR] [Snellen equivalent, &lt;20/200]), and retinal detachment (RD). Results: Fifty eyes of 46 patients were diagnosed with ARN. Varicella-zoster and herpes simplex viruses were the viral etiology in 29 and 16 eyes, respectively. Five were diagnosed on clinical criteria. Intravenous acyclovir was administered in 90% of eyes. Neither induction therapy for ≥13 days ( P = .692) nor intravitreal medication ( P = .203) decreased the incidence of severe vision loss. Maintenance antiviral medication was administered in 96% of eyes (50% received &gt;13 weeks). At final follow-up, 40% of eyes had severe vision loss (range, –0.08 to +3.0 logMAR [Snellen, 20/17-no perception of light]). Forty-six percent developed RD. Relative afferent pupillary defect (RAPD), zone and extent of retinitis, and RD were prognostic of final VA. Antithrombotic therapy was administered in 25/50 eyes and was associated with lower incidence of severe VA loss ( P = .027) and better final VA ( P = .040). Laser retinopexy was performed in 40% of eyes with no significant effect on RD incidence ( P = .901) or severe VA loss ( P = .451). Conclusions: ARN has a high incidence of RD and poor visual outcomes. Aqueous humor PCR is the first-line diagnostic investigation. Prognostic indicators include RD, RAPD, zone, and extent of retinitis. Induction antiviral medication is appropriate for at least 12 days. Antithrombotic medication is associated with improved outcomes. Laser retinopexy does not reduce the incidence of RD.

Treatment of Syphilis-Associated Cerebral Vasculitis: Reappearance of an Old Question

BackgroundCerebral vasculitis caused by neurosyphilis is a re-emerging problem with diagnostic and treatment issues, especially for human immunodeficiency virus patients. MethodsWe present a case of relapsing syphilis-associated cerebral vasculitis, despite the recommended first-line antibiotic treatment, that was successfully treated with a second intravenous penicillin G course and corticosteroids. ResultsA 50-year old man went to the emergency department for bilateral episodes of red and painful eyes with progressive but severe visual acuity loss. He was diagnosed with bilateral panuveitis and neurosyphilis favored by an unknown human immunodeficiency virus infection with a CD4 count of 236 mm3. Despite appropriate and well-conducted treatment including intravenous penicillin G, short-term corticosteroid, and highly active antiretroviral therapy, a symptomatic relapse of the syphilis-associated cerebral vasculitis occurred. After a second course of penicillin and corticosteroids, he made a complete recovery. ConclusionsNeurosyphilis and human immunodeficiency virus co-infection is a reappearing challenging situation that should be considered with care by physicians because recommended antibiotic treatment sometimes fails. Corticosteroid therapy should be discussed in case of cerebral vasculitis.

Baseline Predictors of Visual Acuity Outcome in Patients with Wet Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) is one of the leading causes of severe vision loss in people over 60 years. Wet AMD (wAMD) causes more severe visual acuity (VA) loss compared with the dry form due to formation of choroidal neovascularization (CNV). Antivascular endothelial growth factor (anti-VEGF) agents such as ranibizumab and aflibercept are now the standard of care treatment for wAMD. Unfortunately, up to a quarter of anti-VEGF-treated wAMD patients might not fully benefit from intravitreal injections and CNV activity may not respond to the treatment and these patients are called anti-VEGF nonresponders. This article aims to discuss the baseline factors associated with VA outcome such as age, initial VA, lesion types, disease duration, optical coherence tomography (OCT) features, fundus autofluorescence findings, and the presence of particular genotype risk alleles in patients with wAMD. Recommendations are provided regarding when to consider discontinuation of therapy because of either success or futility. Understanding the predictive factors associated with VA outcome and treatment frequency response to anti-VEGF therapy may help retina specialists to manage patients' expectations and guide treatment decisions from the beginning of treatment on the basis of “personalized medicine.”

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis

ABSTRACTPurposes: The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)—an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes.Methods: Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990–2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis.Results: For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861–0.954) and for observation group patients, 0.368 (range, 0.236–0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610–0.849) and for observation group patients, 0.505 (range, 0.397–0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610–0.849).Conclusions: Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Central retinal vein occlusion: modifying current treatment protocols.

Central retinal vein occlusion (CRVO) is a common retinal vascular disorder that can result in severe visual acuity loss. The randomized control study, CRUISE, helped establish anti-VEGFs as the standard of care in cases with CRVO. The extension studies for CRUISE; HORIZON and RETAIN showed that not all visual gains are maintained beyond the first year. In addition, patients showed different behavior patterns; with some patients showing complete response with few recurrences, whereas others showed partial or even no response with multiple recurrences. Long-term follow-up demonstrated that patients responding poorly to anti-VEGFs tended to do so early in the course of treatment. It also demonstrated the effectiveness of a pro re nata (PRN) protocol for improving vision and maintaining these gains over long-term follow-ups. The SHORE study further illustrated this point by demonstrating that there were minimal differences in visual outcomes between patients receiving monthly injections and patients being treated PRN. In this review we analyzed the data from the major randomized clinical trials (RCT) that looked at anti-VEGFs as the primary treatment modality in patients with CRVO (CRUISE and the extension studies HORIZON and RETAIN for ranibizumab as well as GALILEO and COPERNICUS for aflibercept). In addition, we looked at SCORE and GENEVA to help determine whether there is a place for steroids as a first line therapy in current treatment practice. We then explored alternative treatment regimens such as laser therapy and switching between anti-VEGF agents and/or steroids for non or partially responding patients. Finally, we propose a simplified modified treatment algorithm for patients with CRVO for better long-term outcomes in all types of responders.

Anti-VEGF Pharmacotherapy as an Alternative to Panretinal Laser Photocoagulation for Proliferative Diabetic Retinopathy

From 1976 to 1981, the results of the Diabetic Retinopathy Study identified that panretinal laser photocoagulation (PRP) for high-risk proliferative diabetic retinopathy (PDR) reduced the rate of severe visual acuity loss by more than 50% compared with the natural history of the disease. 1,2 The Diabetic Retinopathy Study identified 4 key risk features of PDR (retinal neovascularization [NV]; NV within 1 disc diameter of the optic disc [NVD]; severe NV [NVD >¼ to ⅓ disc diameters or NV elsewhere >½ disc diameter]; and preretinal or vitreous hemorrhage) and indicated that the presence of 3 or more risk factors constituted high-risk characteristics for developing severe vision loss. 3 The results of the Diabetic Retinopathy Study have served as the basis for the accepted standard of care in the management of PDR for decades. In this issue of JAMA, the investigators from the Diabetic Retinopathy Clinical Research Network (DRCR.net) present the results of a clinical trial comparing PRP and intravitreous ranibizumab among patients with PDR. 4 This noninferiority study included 305 adults with PDR, including 89 participants who had both eyes enrolled, for a total of 394 study eyes. Patients in the ranibizumab group (n = 191 eyes) received intravitreous ranibizumab (0.5 mg) (and PRP if treatment failed) and received ranibizumab as needed for diabetic macular edema, whereas patients in the PRP group (n = 203 eyes) re

Recovery of visual functions in amblyopic animals following brief exposure to total darkness

Occlusion of one eye of kittens (monocular deprivation) results in a severe and permanent loss of visual acuity in that eye, which parallels closely the vision loss characteristic of human amblyopia. We extended earlier work to demonstrate that amblyopic vision loss can be either blocked or erased very fast by a 10 day period of total darkness following a period of monocular deprivation that begins near birth and extends to at least 8 weeks of age. The parameters of darkness were strict because no visual recovery was observed after 5 days of darkness. In addition, short periods of light introduced each day during an otherwise 10 day period of darkness obliterated the benefits. Despite recovery of normal visual acuity, only one-quarter of the animals showed evidence of having attained normal stereoscopic vision. A period of total darkness may catalyse and improve treatment outcomes in amblyopic children. A 10 day period of total darkness has been shown to either block or erase the severe effects on vision of a prior short period of monocular deprivation (MD) in kittens depending on whether darkness is contiguous or is delayed with respect to the period of MD. We have extended these earlier findings from kittens for which the period of MD began at 1 month and lasted for 1 week to more clinically relevant situations where MD began near birth and lasted for ≥ 6 weeks. Despite the far longer MD and the absence of prior binocular vision, all animals recovered normal visual acuity in the previously deprived eye. As before, when the period of darkness followed immediately after MD, the vision of both eyes was initially very poor but, subsequently, the acuity of each eye increased gradually and equally to attain normal levels in ∼ 7 weeks. By contrast, when darkness was introduced 8 weeks after MD, the visual acuity of the deprived eye recovered quickly to normal levels in just 1 week without any change in the vision of the fellow (non-deprived) eye. Short (15 or 30 min) periods of illumination each day during an otherwise 10 day period of darkness obliterated all the benefits for vision, and a 5 day period of darkness was also completely ineffective. Measurements of depth perception indicated that, despite possessing normal visual acuity in both eyes, only about one-quarter of the animals showed evidence of having attained normal stereoscopic vision.

Blood pressure control for diabetic retinopathy.

Blood pressure control for diabetic retinopathy.

Blood pressure control for diabetic retinopathy.

Blood pressure control for diabetic retinopathy.

Lebersche hereditäre Optikusneuropathie – Klinik, Genetik, therapeutische Optionen

Leber's hereditary optic neuropathy is a rare genetic disorder affecting the retinal ganglion cells leading to a persistent severe bilateral loss of visual acuity within weeks or months. Males are much more likely to be affected than females, disease onset in most cases takes place between age 15 and 35 years. The disease is caused by point mutations in the mitochondrial DNA. The penetrance of the disease is incomplete, i.e., not all mutation carriers develop clinical symptoms. The phenotype is relatively uniform, but age at onset, severity and prognosis may vary even within the same family. Environmental and endocrine factors, optic disc anatomy as well as mitochondrial and nuclear genetic factors are discussed to influence penetrance as well as interindividual and intrafamilial variability. However, only cigarette smoking and excessive alcohol consumption have been shown to trigger disease onset. The disease is characterised by a central visual field defect, impaired colour vision and fundoscopically a peripapillary microangiopathy in the acute phase. Most patients end up after some months with a severe visual loss below 0.1 and in most cases there is no significant improvement of visual acuity in the course. In rare cases patients experience a mostly partial visual recovery which depends on the type of mutation. For confirmation of the diagnosis a detailed ophthalmological examination with fundoscopy, family history and genetic analysis of the mitochondrial DNA is needed. To date, there is no proven causal therapy, but at early disease stages treatment with idebenone can be tried.

Paintball-related ocular trauma: Paintball or Painball?

BackgroundThe aim of this study is to describe the type and severity of paintball-related ocular trauma and to determine the necessary precautions to minimize the risk of ocular injury regardless of whether adequate eye protection was used.Material/MethodsA retrospective chart review identified patients treated for paintball-related ocular trauma at the Ataturk University Medical Hospital from June 2010 through March 2013. A descriptive analysis of data was performed.ResultsTen patients with paintball-related ocular trauma were identified. At the time of their first examination, 7 of these patients had visual acuity (VA) of 20/200 or worse. One patient had a final VA of no light perception and 4 patients had a final VA of 20/200 or worse. Hyphema was noted in 7 patients, traumatic cataract in 2, iridodialysis in 2, retinal detachment in 3, and secondary glaucoma in 1. Six patients required surgery. Although all victims have used eye protection during the game, all patients were injured after they thought the game was over and had taken off their helmets or eye-protective devices.ConclusionsPaintball-related accidents result in serious ocular trauma and most of the patients require surgery. These injuries result in severe loss of VA in some patients. Uninterrupted use of proper eye protection whenever a player is in the game field, even after they believe the game has ended, may reduce the incidence of severe ocular trauma in paintball players.

Comparison of Visual Field Parameters in Early and Advanced Stages of Multiple Sclerosis Patients Without a History of Optic Neuritis

This study compared the visual field parameters of multiple sclerosis patients without optic neuritis in early versus advanced stage of the disease. Patients were divided into two groups: group 1 (early stage, n = 14) constituted of patients with Expanded Disability Status Scale scores <3 and group 2 (advanced stage, n = 13) constituted of patients with Expanded Disability Status Scale scores ≥3. Mean visual acuities in both groups were similar (p = 0.674). Mean sensitivity, mean defect, loss of variance, reliability factor parameters (Octopus 101 perimeter) of groups 1 and 2 were 24.17 ± 3.62, 21.81 ± 3.04; 4.14 ± 3.05, 6.49 ± 2.58; 21.61 ± 22.17, 33.31 ± 18.67; and 1.57 ± 2.79, 2.59 ± 3.09, respectively. Compared with group 1, mean sensitivity was significantly lower in group 2 (p = 0.013). Mean defect (p = 0.004) and loss of variance (p = 0.042) parameters in group 2 were significantly higher than in group 1. Mean reliability factor was similar between two groups (p = 0.211). Multiple scleorisis may alter visual field parameters without severe loss of visual acuity by possibly involving optic pathways other than optic nerve.

Visual Acuity Changes in Patients With Leber Congenital Amaurosis and Mutations in CEP290

To evaluate changes in visual acuity (VA) over time in patients with Leber congenital amaurosis (LCA) and mutations in the CEP290 gene. Visual acuity was determined at the initial and most recent visits of 43 patients with LCA and CEP290 mutations. The main outcome measures included the best-corrected VA at the initial and most recent visits, as well as the correlation between age and VA. At the initial visit, 14 patients had measurable chart VA in the better-seeing eye, 25 patients had nonmeasurable chart VA, and 4 young patients did not have VA assessed. At the most recent visit, 15 patients had measurable chart VA and 28 had nonmeasurable chart VA. The average interval between the 2 visits was 10.4 years (range, 2-47 years). For patients with measurable chart VA, the median logMAR value at the initial visit (0.75; range, 0.10-2.30) and at the most recent visit (0.70; range, 0.10-2.00) did not differ significantly (P> .05). There was no significant relationship between VA and age. Patients with LCA and CEP290 mutations had a wide spectrum of VA that was not related to age or length of follow-up. Severe VA loss was observed in most, but not all, patients in the first decade. These data will help clinicians provide counseling on VA changes in patients with CEP290 mutations and could be of value for future treatment trials.

Dangerous waters: outbreak of eye lesions caused by fresh water sponge spicules

To describe an extremely uncommon outbreak of eye lesions in a specific area of the Brazilian Amazonia. Prospective noncomparative case series. Fifty-nine patients who developed eye lesions after swimming in the Araguaia river of Tocantins state in Brazil were examined. A team of ophthalmologists equipped with a slit-lamp, gonioscopic lenses, and indirect ophthalmoscopy performed full eye examination. Analysis of the flora and fauna of the river water was undertaken by a group of experts. Eighty-three eyes were affected. The most common lesions were corneal opacities seen in 34 eyes and conjunctival nodules diagnosed in 12 eyes. Severe visual acuity loss was detected in seven children with unilateral anterior chamber lesions. Spicules of the sponge species Drulia uruguayensis and Drulia ctenosclera were found inside three blind eyes that have been enucleated for diagnostic purposes. All eye lesions could be attributed to an outbreak of foreign bodies from fresh water sponges. Organic enrichment of the water resulting from the absence of sanitation probably was the key factor, which initiated a cycle of ecological imbalance that provoked human disease.