Cross-Linking Pack Plus Plasma in the Mycotic Corneal Ulcer Case Report.

Fungal keratitis is a complication of refractive surgery that, if not treated in time, can lead to blindness. Given the lack of effective topical treatments for fungal ulcers, surgical treatment is necessary. The least invasive procedure is a cross-linking pack, although it has limitations when the fungus has penetrated the deep layers of the cornea. In this case report, a patient that presented a typical case of fungal corneal ulcer with hand motion perception, on the fourth day after surgery, is described. Given the nonresponse to topical antifungal treatment, plasma treatment was performed prior to cross-linking. Plasma acts by nonmechanical debridement of the ulcer, reducing the fungal colonies and allowing better penetration of riboflavin. After 6 months, the cornea remained transparent, without haze, and the patient achieved 20/25 vision.

Uso terapéutico de la hialuronidasa y la triamcinolona en el pseudotumor orbitario / Therapeutic use of hyaluronidase and triamcinolone in orbital pseudotumor

RESUMEN El origen del pseudotumor orbitario no es del todo conocido. Se admite su naturaleza inflamatoria granulomatosa e inespecífica en diferentes localizaciones. El pseudotumor orbitario se define como una respuesta inflamatoria celular pleomórfica, que está usualmente confinado a estructuras de la órbita y tiene una evolución limitada. En este trabajo se presenta una paciente femenina de 16 años, con diagnóstico de pseudotumor orbitario corroborado por biopsia y tomografía axial computarizada, refractaria al tratamiento con esteroides sistémicos, por lo que se decide iniciar con la aplicación de hialuronidasa y triamcinolona en el espacio peribulbar. Los casos agudos casi siempre responden rápidamente al tratamiento con cortocoesteroides, como prednisona, pero debemos tener en cuenta que existen pacientes que son refractarios al tratamiento, por lo que es necesario buscar procedimientos alternativos. Una opción es el uso de hialuronidasa para destruir las uniones extracelulares, y difundir un esteroide de manera local, como la triamcinolona, más efectiva dentro del tejido inflamatorio para provocar un efecto localizado de este. A los tres meses del tratamiento hubo una regresión total del cuadro en esta paciente(AU)

ABSTRACT The exact etiology of orbital pseudotumor is unknown, but its granulomatous unspecific inflammatory nature at various locations has been recognized. Orbital pseudotumor is defined as a cellular pleomorphic inflammatory response of limited evolution often confined to orbital structures. A case is presented of a female 16-year-old patient diagnosed with orbital pseudotumor confirmed by biopsy and computerized axial tomography, refractory to treatment with systemic steroids, due to which it is decided to start treatment with hyaluronidase and triamcinolone in the peribulbar space. Acute cases often respond fast to treatment with corticosteroids such as prednisone. It should be borne in mind that there are patients who are refractory to treatment for whom alternative treatments should be sought. An option is the use of hyaluronidase to destroy extracellular junctions and locally spread a steroid such as triamcinolone, most effectively within the inflammatory tissue to ensure its localized effect. Total regression of the patient's status was observed at three months of treatment(AU)

Melanoma uveal de cuerpo ciliar / Uveal melanoma of ciliary body

RESUMEN El objetivo de este reporte de caso fue identificar las características de un nevo abultado conjuntival en una paciente femenina de 72 años de edad. Se muestran las pruebas complementarias realizadas para llegar al diagnóstico de melanoma conjuntival, que consiste en un tumor poco frecuente, el cual constituye el 2 por ciento de todos los tumores del ojo. Las células involucradas son los melanocitos del epitelio conjuntival. Un factor de riesgo para esta entidad puede ser la exposición a la luz ultravioleta; sin embargo, esto no está bien determinado. La mayoría de los casos se originan de una melanosis adquirida primaria (50-70 por ciento). La presentación más común es una lesión pigmentada, unilateral, elevada, gruesa, con vasos sanguíneos y áreas de melanosis a su alrededor. Su diagnóstico se realiza con la sospecha clínica que se confirma con el estudio histopatológico. El tratamiento en la actualidad es la excisión local, seguida de crioterapia, radioterapia o quimioterapia. La enfermedad matastásica ocurre en el 11 - 42 por ciento y en el 20 - 52 por ciento de los pacientes en un seguimiento de 5 y 10 años, respectivamente(AU)

ABSTRACT The objective of this case report is to describe the characteristics of a conjunctival bulging nevus in a 72-year-old female patient and the complementary tests that were performed to reach the diagnosis of conjunctival melanoma. Conjunctival melanoma is a rare tumor, which account for 2 percent of all eye tumors. The cells involved are the melanocytes of the conjunctival epithelium. A risk factor for this entity may be exposure to ultraviolet light. However, it has not been precisely described. Most cases originate from a primary acquired melanosis (50-70 percent). The most common presentation is a pigmented, unilateral, elevated, thick, lesion with blood vessels and areas of melanosis around it. Its diagnosis is made with the clinical suspicion confirmed with the histopathological study. Current treatment is local excision, followed by cryotherapy, radiotherapy, or chemotherapy. Metastatic disease occurs in 11-42 percent and 20-52 percent of patients in a 5-year and 10-year follow-up, respectively(AU)

Limbal Stem Cell Allografts and Corneal Transplant in a Patient with Severe Corneal Melting and Perforation due to Thermokeratoplasty and Cross-Linking Treatment Burn.

PURPOSE: To report corneal stem cell allografts in a patient with a persistent epithelial defect as well as corneal melting and perforation due to severe ultraviolet light burn and thermokeratoplasty treatment for keratoconus. METHODS: A 21-year-old female patient with corneal melting, perforation and a persistent epithelial defect in her left eye secondary to iatrogenic treatment for keratoconus, thermokeratoplasty and cross-linking was treated with penetrating keratoplasty, using a 9.0-mm diameter corneal graft and limbal stem cell allograft implants. At the end of the procedure, subtenonian injections of a combination of bevacizumab and triamcinolone were given. RESULTS: The patient had a favorable outcome 48 h after surgery, with an improvement of symptoms and a complete corneal healing. By the third week after surgery, she had a best-corrected visual acuity of 20/60 and a clear corneal graft, which remained stable for the 9 months of follow-up. CONCLUSIONS: Treatment with limbal stem cell allografts and penetrating keratoplasty in a female patient with a large corneal defect and melting in her left eye was effective. Larger studies are warranted to explore the real impact of this procedure.