[Sclerokeratitis and invasive conjunctival squamous cell carcinoma]. / Escleroqueratitis y carcinoma escamoso conjuntival invasivo.

PURPOSE/METHODS: To describe one case of invasive squamous cell carcinoma of the conjunctiva in a 74-year-old woman, who two years previously had presented with a lesion which appeared to be an anterior nodular scleritis. RESULTS/CONCLUSIONS: An anterior nodular scleritis, which did not respond to therapy, preceded the development of a squamous cell carcinoma of the conjunctiva adjacent to it. In our patient, the conjunctival squamous cell carcinoma could have masqueraded as a scleritis, delaying the correct diagnosis and allowing orbital spread of the tumor. A diagnosis of neoplasia must be considered when a scleritis shows an atypical appearance or does not respond to the usual therapy.

[Treatment with topical interferon alone in severe conjunctivo-corneal neoplasia]. / Interferón tópico como tratamiento único en un caso de neoplasia córneo-conjuntival severa.

CASE REPORT: A 78-year-old man was referred for evaluation of a limbic lesion in his left eye. This had a gelatinous appearance and an extension of 240 degrees . The lesion was clinically diagnosed to be a conjunctival and corneal intraepithelial neoplasia (CIN). Topical treatment with interferon alpha2b (INFalpha2b) four times daily was started and continued until the lesion had completely resolved at 4 months. DISCUSSION: Topical INFalpha2b alone may be a safe and effective treatment of CIN instead of the other classic alternatives such as surgical excision with cryotherapy, which could induce the development of severe limbic deficiency in cases with extensive disease.

[Interferon alfa-2b treatment in selected cases of recurrent conjunctival intraepithelial neoplasia]. / Empleo de interferón alfa-2b para el tratamiento de carcinomas conjuntivales intraepiteliales en casos seleccionados.

PURPOSE: To study the efficacy of topical and combined topical and subconjunctival interferon alfa 2b (IFN alfa 2b) in the treatment of recurrent conjunctival intraepithelial neoplasia (CIN) in those patients who present resistance or intolerance to topical mitomycin C (MMC) treatment or when it is not indicated. METHODS: Four patients (age range from 52 to 70) with histological confirmation of recurrent CIN were studied prospectively. Two patients were resistant to topical MMC, another one did not tolerate it, and in the last case, this treatment was not indicated due to a stem cell insufficiency associated to a trophic corneal ulcer. Three patients were given just topical interferon (1 million IU/ ml four times a day for three months), while the last one received topical therapy and subconjunctival IFN alfa 2b injections (3 millions IU/ 0.5 ml). RESULTS: Complete regression of the tumour was evident in all cases. sixteen to 24 months after treatment no patient had clinical evidence of recurrence. No side effects were observed in any patient, not even with subconjunctival administration. CONCLUSIONS: IFN alfa 2b is effective as an alternative treatment to topical MMC in selected cases of recurrent CIN.

[Severe retinal phlebitis in ocular bartonellosis]. / Flebitis retiniana severa en bartonelosis ocular.

PURPOSE/METHODS: To report the clinical case of a 34-year-old male with atypical ophthalmic manifestations of cat-scratch disease (ocular bartonellosis), including an extensive retinal phlebitis, as well as the evolution of the clinical picture with treatment. RESULTS/CONCLUSIONS: The clinical diagnosis of ocular bartonellosis was serologically confirmed. Oral treatment with ciprofloxacine healed the phlebitis and the neuroretinitis, with a residual optic disk pallor. This case exemplifies the diversitiy of ocular manifestations of this disease. The authors recommend considering this condition in the differential diagnosis of posterior uveitis in young patients.

[Neurotrophic keratopathy management with cyanoacrylate tarsorraphy and autologous serum]. / Manejo de la queratopatía neurotrófica mediante tarsorrafia con cianoacrilato y suero autólogo.

PURPOSE/METHODS: Neurotrophic keratopathy is a degenerative corneal disease with a highly complex treatment caused by an impairment of corneal sensitivity. We report the case of a 47 year-old man with a refractory postherpetic neurotrophic keratopathy in his right eye and we discuss the treatment options. RESULTS/CONCLUSION: The combination of cyanoacrylate with temporary tarsorraphy along with the administration of topical autologous serum eyedrops and systemic tetracycline, allowed to control the progression of the disease and to regenerate the corneal surface. This unpublished therapeutic strategy might be an effective and safe alternative in the management of neurotrophic keratopathy (Arch Soc Esp Oftalmol 2003; 78: 119-122).

[Paralytic ectropion correction with porous polyethylene spacer by subciliar external approach]. / Corrección del ectropión paralítico con implante de espaciador de polietileno poroso por abordaje externo subciliar.

PURPOSE: To evaluate the efficacy of porous polyethylene spacer in paralytic ectropion. METHODS: Nine eyes of 8 patients (5 male and 3 female, medium age 55.6 S.D. 11.2 years) with paralytic ectropion were operated. All of them presented a scleral show of more than 3 mm, exposure queratopathy and epiphora grade III-IV in Munk scale. A tarsal strip procedure, internal cathoplasty and porous polyethylene spacer sutured to the inferior border of the tarsal plate and over the palpebral retractors by subciliar external approach were performed. RESULTS: The mean followup time was 9.8 S.D. 4.3 months. The scleral show, exposure queratopathy and epiphora improved in all patients. There were two extrusions of the synthetic material, with removal of the implant in one of them. In these two cases a long lasting facial palsy with miocutaneous atrophy was the cause of the ectropion. CONCLUSIONS: Porous polyethylene speacer is a good alternative for paralytic ectropion treatment. This technique decreases the risk of infectious disease transmission as in homologous grafts and the need of a second surgical procedure as in autologous grafts.

[Bilateral lagophthalmos in lepromatous leprosy. Case report]. / Lagoftalmos bilateral en paciente con lepra lepromatosa. Caso clínico.

CASE REPORT: A case of bilateral facial palsy with paralytic ectropion, lagophthalmos and corneal damage secondary to corneal exposure in a long-standing patient with lepromatous leprosy is presented. Correction of paralytic ectropion was performed by medial cantoplasty, tarsal strip and Medpor lower eyelid spacer implantation. Lagophthalmos was corrected by gold weight implant in the upper tarsus. DISCUSSION: Ocular findings in leprosy appear in 72% of patients. Facial nerve palsy occurs in 3-19.8%, being bilateral in 5%. In long standing cases with corneal complications secondary to exposure, surgical treatment is required.

[Mycotic dacryocystitis related to naso-lacrimal stent. Case report]. / Dacriocistitis micótica asociada a prótesis naso-lagrimal. Caso clínico.

CASE REPORT: A nasolacrimal stent was placed in a diabetic woman with a ten-year history of epiphora. Three months later the non-functional stent was removed and taken for histological study. A presumed diagnosis of fungical dacryocystitis was then established. An external dacryocystorhinostomy was performed and the obtained cultures confirmed Candida albicans as the infective agent. DISCUSSION: Only 1.2% of all dacryocystitis are due to fungal agents. This possibility must be considered when evaluating a routine chronic dacryocystitis. Cultures should be obtained when removing a nasolacrimal stent in order to rule out different causes of nasolacrymal obstruction.

[Pseudomonas aeruginosa corneal abscess refractory to fluoroquinolones]. / Absceso corneal por pseudomonas aeruginosa resistente a fluoroquinolonas.

PURPOSE/METHOD: To report a clinical case of a 21-year old male with a severe corneal abscess due to Pseudomonas aeruginosa refractory to intensive treatment with topical Ciprofloxacin. RESULTS/CONCLUSIONS: A corneal scrapping performed after a wash-out period showed Pseudomonas aeruginosa specimens, which were not sensitive to any of the fluoroquinolones tested. A fortified topical treatment with Ceftazidime healed the corneal abscess. Nowadays, the possibility of resistance to fluoroquinolones should be kept in mind, and we recommend treatment guided by the results of a microbiological study in severe and sight-threatening cases.