Effects and safety of perfluorohexyloctane on the eye surface and corneal endothelium. / Efectos y seguridad del perfluorohexiloctano en la superficie ocular y el endotelio corneal.

OBJECTIVE: To evaluate the effects and safety of topical drops of perfluorohexyloctane (F6H8) on the ocular surface and the corneal endothelium. METHODS: Forty-five patients (90 eyes) diagnosed with dry eye disease were recruited and prescribed treatment with F6H8 as part of a six-month prospective multicentre study. Variables in corneal staining were documented using the National Eye Institute/Industry Workshop scale. The conjunctival variables included using the Oxford scale, as well as corneal parameters, such as central corneal thickness, cell density, coefficient of variation, hexagonality, and mean cell area, at the start of the study, and at 3months and 6months. Compliance and satisfaction with the treatment were measured. RESULTS: F6H8 drops reduced mean corneal staining based on the NEI scale in compliant patients to a mean of -0.84 ± 1.95 at 3months (P=.001) and to -1.65 ± 2.42 at 6months (P<.001). Conjunctival staining at 6months showed a mean decrease of -0.13 (P=.319). The endothelial parameters did not show a significant difference, in contrast to the central corneal thickness that showed a statistically significant decrease (545.30 ± 32.25 at the start of the study to 538.40 ± 31.36 after 6months, P=.009). At the end of the study, 46% of patients reported feeling subjectively better, 40.5% felt the same, and 13.5% felt subjectively worse. CONCLUSIONS: Topical treatment with F6H8 for dried eye disease did not alter the measured variables of the corneal endothelium, but showed improvement in corneal staining and satisfaction.

Fuchs' dystrophy associated with radial keratotomy: Lamellar or perforating keratoplasty? / Distrofia de Fuchs asociada a queratotomía radial: ¿queratoplastia penetrante o lamelar?

CASE REPORT: A 70 year-old male patient with a history of radial keratotomy suffering from Fuchs' dystrophy and a cataract. The patient received a two-step surgery: lens phacoemulsification and intraocular lens implant, followed by descemet stripping automated endothelial keratoplasty in both eyes, four months later. There were no complications apart from a recurrent cystoid macular oedema in both eyes. The best corrected visual acuity was 20/40 both eyes, and the patient was satisfied. DISCUSSION: Descemet stripping automated endothelial keratoplasty may be considered as an alternative to penetrating keratoplasty in the case of endothelial dysfunction and radial keratotomy in patients with no corneal ectasia or significant stromal opacity.

Topical tacrolimus 0.03% for the treatment of ocular psoriasis. / Tacrolimus tópico al 0,03% en el tratamiento de la psoriasis ocular.

OBJECTIVE/METHODS: Cases are presented of 4 patients suffering from severe symptoms due to ocular psoriasis and who were treated with off-label 0.03% tacrolimus once a day. RESULTS/CONCLUSIONS: All four patients had a mixed blepharitis and keratitis. Pseudopterygium and corneal opacities were present in three of them. All of them experienced an improvement of their itching and ocular surface. They all referred to a marked improvement of their quality of life in a follow-up period ranging from six months to two years. Therefore, topical tacrolimus could be considered an option in the treatment of ocular psoriasis.

A new oct sign of invasive squamous cell carcinoma of the cornea.

CASE REPORT: A case is reported of an unusual progressive corneal opacification and neovascularization caused by a squamous cell carcinoma (SCC) of the cornea. A patient with a white stromal infiltrate, consistent with herpetic stromal keratitis, showed a very particular image in optical coherence tomography (OCT), resembling a "tongue of lava" sliding between corneal lamellae. Histopathological analysis confirmed the diagnosis of SCC. DISCUSSION: To our knowledge this is the first report in the literature of this peculiar image with OCT. Squamous Cell Carcinoma is an extremely rare cause of progressive corneal opacification and neovascularization, and a delayed diagnosis may lead to unsuccessful treatment and loss of the eyeball.

Anterior stromal puncture for the treatment of Brown-McLean syndrome.

CASE REPORT: The Brown-McLean syndrome is defined by peripheral corneal edema sparing the central cornea. We report a patient with bullous annular keratopathy following phacoemulsification and implantation of posterior chamber intraocular lens. The uncorrected and best corrected visual acuity was 20/30. The patient required the use of a bandage contact lens for almost 5 years to relieve the ocular discomfort. DISCUSSION: Anterior stromal puncture was performed using a cystotome. Two weeks after the procedure the ocular discomfort disappeared and the use of bandage contact lens was no longer required. Anterior stromal puncture is a simple procedure that is performed under the slit lamp, and can alleviate the symptoms in patients with Brown-McLean syndrome.

Deep anterior lamellar keratoplasty in post-laser in situ keratomileusis keratectasia.

We describe a technique using deep anterior lamellar keratoplasty (DALK) in 5 eyes that developed keratectasia after LASIK. The technique is based on surgical manipulation that allows visualization of the lamellar dissection depth using a posterior approach to reach the predescemetic space. The mirror effect, indentation effect, and folding effect were used to determine proximity to Descemet's membrane. The same diameter donor and recipient buttons were used to correct myopia. The donor button without Descemet's membrane was placed using 10-0 nylon sutures. No intraoperative or postoperative complications occurred. The mean best spectacle-corrected visual acuity changed from 0.16 diopter (D) +/- 0.05 (SD) (range 0.10 to 0.25 D) before DALK to 0.68 +/- 0.19 D (range 0.5 to 1.0 D) after DALK. Deep anterior lamellar keratoplasty may be a better alternative than penetrating keratoplasty for any pathology with healthy endothelium.

[Corneal descompensation in patients with endothelial compromise treated with topical dorzolamide]. / Descompensación corneal en pacientes con compromiso endotelial tratados con dorzolamida tópica.

PURPOSE: To investigate the possibility of corneal alterations in patients with long-term endothelial compromise with topical dorzolamide. MATERIAL AND METHODS: Retrospective descriptive study of 17 patients with penetrating keratoplasty and glaucoma associated with topical carbonic anhydrase inhibitor therapy, looking for coincidence with corneal alteration. RESULTS: Classified by ethiology, type of glaucoma and control, recording previous ophthalmological surgeries, evolution time, complications and rejection episodes. Seven patients suffered a corneal decompensation, in three of them there were signs of true reject but only four cases had edema at the beginning of dorzolamide treatment, one of them recovering after stopping dorzolamide. Risk factors were previous cataract surgery, mainly aphakia, filtering surgery and previous vitrectomy. CONCLUSIONS: Dorzolamide could have a potential negative effect on patients with endothelial compromise.