Early Penetrating Keratoplasty after interface fungal keratitis in Descemet Membrane Endothelial Keratoplasty. / Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet.

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn't show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.

[Intraocular phakic lens ZSAL-4 for high myopia correction]. / Lente ZSAL-4 para la corrección de la alta miopía.

PURPOSE: To evaluate the effectiveness, safety and predictability of the phakic intraocular lens (IOL) ZSAL-4 for correction of high myopia. METHODS: In this retrospective study 28 IOL in 19 patientes were implanted. The following data were recorded, preoperatively, one week, one month, 3, 6 and 12 months postoperatively: spherical equivalent (SE), astigmatism, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), endothelial cell density (CD), coefficient of variation (CV) and intraocular pressure (IOP). We performed LASIK in 3 eyes to correct a residual refractive defect. RESULTS: The mean age was 29.7 S.D. 5.77 years and the mean following 7.62 S.D. 7.29 months. Six months postoperatively, the preoperative SE of -14.91 S.D. 2.88 was reduced to -1.29 S.D. 0.53; the BCVA varied from 0.56 S.D. 0.16 to 0.58 S.D. 0.12; the CD changed from 2670 S.D. 252 cells/mm2 to 2344 S.D. 262. The CV showed stability. The UCVA six months postoperatively was 0.39 S.D. 0.15. No eyes lost any line of BCVA; during the first month 63% of the eyes won 2 or more lines. The efficacy index was 0.83 S.D. 0.24 one month postoperatively and 0.63 S.D. 0.32 one year postoperatively; the safety index was 1.44 D.S. 0.34 and 1.30 S.D. 0.35 respectively. One IOL was explanted the second day due to pupilary blockage; 7 eyes had transient high IOP; 2 eyes developed pupilary ovalization and in 4 cases the IOL suffered some degree of rotation. One eye presented a flat retinal detachment one year postoperatively but with no other complications. The 3 eyes submitted to LASIK presented 0.8 of BCVA the third month after LASIK. CONCLUSIONS: ZSAL-4 IOL implantation is an effective and safe procedure with an acceptable predictability which, in some cases, could be improved with LASIK.