Massive retinal gliosis (MRG) is a rare, benign intraocular condition resulting from reactive glial cells undergoing exaggerated repair phenomenon. A 52-year-old male presented with 6-year history of enlarging mass in the right eye, associated with progressive vision loss and worsening proptosis. He reported history of trauma to that eye secondary to a vehicular crash one year prior. Magnetic resonance imaging (MRI) of the orbits revealed an intraocular lesion with calcifications raising the possibility of a malignant tumor. Enucleation of the right globe was performed and histopathologic examination revealed the entire vitreous cavity and retina replaced by glial cells arranged in interlacing bundles and whorls with foci of calcifications, highly suspicious of MRG. This was further confirmed by a positive, diffuse, and robust cytoplasmic expression of glial fibrillary protein (GFAP). The disease is known to have favorable outcomes as no complications, such as reemergence of the mass, active bleeding, and secondary infection, were observed from the patient during subsequent visits. Distinction of MRG from other intraocular neoplasms is clinically challenging, hence biopsy is necessary. MRG should be considered as a differential diagnosis when encountering intraocular tumors, especially if there is a history of eye trauma. This is the first reported case of MRG in the Philippines.
Human ; Female ; Middle Aged: 45-64 yrs old ; retinal tumor ; retinal neoplasms

Objective: This study determined the prevalence of depression among young ophthalmologists during the COVID-19 pandemic and determined their access to mental healthcare. Methodology: In this cross-sectional study, members of the Philippine Network of Young Ophthalmologists were surveyed using an online Patient Health Questionnaire-9 (PHQ-9), a short self-administered tool which included questions related to their current work to assess depression. The respondents were also asked if there was available, accessible, affordable, adequate, and acceptable mental healthcare to them answerable by yes, no, or maybe. Results: Seventy (70) respondents were included in the analysis. The mean age was 33±5 years with 54% being female. Forty-five (45) or 64% were resident trainees with a mean number of years in the training of 2±1 years. The median score for the PHQ-9 was 6.5 (3,12). Forty-two (42) or 60% of the respondents had some degree of depression. Nine (9) or 13% of the respondents had no available service, 6 (9%) had no accessible service, 7 (10%) had no affordable service, and 4 (6%) had no adequate service for mental healthcare for them. Conclusion More than half of the ophthalmologists-in-training and newly practicing suffered from some degree of depression based on the PHQ-9 questionnaire. A significant proportion was either not sure or do not have available, accessible, affordable, and adequate mental healthcare services for them.
Mental Health ; COVID-19 ; Patient Health Questionnaire

Congenital divided nevus of the eyelids is a rare form of melanocytic nevus which involves contiguous portions of the upper and lower eyelid margins unilaterally, hence the term ‘kissing nevus’. While usually present at birth, these nevi may also appear later in life. When the mass enlarges, it may cause cosmetic issues to the patient, as well as functional problems such as mechanical ptosis, ectropion, and epiphora.

We report three cases of congenital divided nevus of the eyelids, all presenting with unilateral upper and lower hyperpigmented lid masses since birth. The first case had an upper lid mass measuring 11 mm x 19 mm, and a lower lid mass measuring 55 mm x 47 mm, with both masses extending into the palpebral conjunctiva, and causing severe ptosis and corneal neovascularization due to chronic irritation. The second case presented with hyperpigmented masses at the lateral third of the right upper eyelid measuring 8 mm x 17 mm and of the lower eyelid measuring 9 mm x 15 mm on the lower lid with lashes growing through the masses. There was extension of the mass into the palpebral conjunctiva. The third case presented with a 23 x 18 mm hyperpigmented, well-circumscribed, verrucated mass at the medial half of the upper eyelid crossing the eyelid margin, and a 15 x 13 mm lesion at the medial third of the lower lid with the same characteristics, with small crusty lesions and clotted blood. All three patients underwent excision biopsy with lid reconstruction using full thickness skin grafts from the supraclavicular area. Six months postoperatively, the first case underwent a repeat full thickness skin graft due to graft contraction, and also received two sessions of fractional carbon dioxide (CO2 ) laser, two sessions of intralesional triamcinolone injections, and silicone gel application with further improvement of graft healing and scarring. The second case also underwent two sessions of intralesional steroid injection for scar management. During follow-up, which spanned 13 months for the first case, 10 months for the second case, and two months for the third case, improved functional and cosmetic outcomes were observed.

This case series highlights the outcomes of the most common surgical technique done for congenital divided nevi of the eyelids. Congenital divided nevi are usually diagnosed clinically and malignant degeneration is rare, hence lid reconstruction may be done without frozen section. The cases in the series were treated due to cosmetic and functional purposes, hence the importance of continuous post-operative follow-up to monitor for graft dehiscence, scar development, recurrence of the mass, malignant degeneration, and development of lid malposition. Additional procedures for scar management, such as CO2 laser and intralesional steroid injections, may be necessary to further enhance outcomes in complex cases. All three cases in this series exhibited improved functional and cosmetic outcomes post-operatively, with significant reduction in ptosis and scarring. Longterm follow-up revealed satisfactory recovery with minimal complications, with no recurrence nor malignant degeneration.

Human ; Male ; Female ; Adult: 25-44 Yrs Old ; Young Adult: 19-24 Yrs Old ; Nevus ; Nevus, Pigmented