Review of the literature on the currently available evidence for the management of infectious keratitis with PACK-CXL.

Infectious keratitis (IK) is one of the most common causes of monocular blindness worldwide, especially in developing countries and may account for 5.1%-32.3% of all indications for penetrating keratoplasty (PK). However, performing a therapeutic PK on a "hot eye" is associated with a higher incidence of IK recurrence and graft rejection. Standard treatment includes antimicrobials (ATM) and, once the causative pathogen has been identified, must be continued with targeted treatment, depending on antibiogram sensitivity. However, appearance of multiresistant strains to ATM is progressively increasing at an alarming rate. Besides that, the diversity of the causative microorganisms (bacteria, fungi, parasites, viruses) may hinder the clinical diagnosis and secondarily the proper treatment from the beginning. It is estimated that only 50% of eyes will have a good visual result if the correct therapy is delayed. All these factors make the identification of alternatives to ATM treatment of paramount importance. Due to the ATM properties of photoactivated chromophore (riboflavin, RB) and ultraviolet (UV) light of wavelength (λ) 200-400 nanometers (nm), used in multiple medical and non-medical applications for disinfection, photoactivated chromophore for corneal cross-linking (CXL) of IK (PACK-CXL), as an addition to the therapeutic arsenal for the management of IK has been proposed. It must be differentiated from CXL used for the management of progressive keratoconus (KC). The objective of this review is to update the available evidence on the efficacy and safety of PACK-CXL in IKs.

"White-puncture": A simple technique to prevent tearing of the anterior capsule during capsulorhexis in intumescent white cataracts. / Blancopunción: una técnica simple para prevenir el desgarro de la cápsula anterior durante la capsulorrexis en cataratas blancas intumescentes.

In order to avoid radial tearing of the anterior capsule while performing continuous circular capsulorhexis (CCC) in a white intumescent cataract, called the "Argentinian flag sign" when CCC is associated with a previous capsular stain with trypan blue, an initial puncture of the anterior capsule is performed with a 30G needle as the first step of the surgical procedure, that means, prior to any previous aperture of the anterior chamber. This act seems to allow the pressure of the intracrystalline space and the pressure of the anterior chamber to be equalized, as the liquefied content of the intumescent white cataract is released into a presumably hermetic anterior chamber, avoiding the dreaded anterior capsular radial tear. This technique, called "white-puncture", has been used in 174 cases without any associated complications.

[Choroidal metastases in breast and lung cancer. Prevalence and clinical features. A prospective study]. / Las metástasis coroideas en el cáncer de mama y pulmón. Prevalencia y características clínicas. Estudio prospectivo.

PURPOSE: To analyze the prevalence of choroidal metastases in patients with breast and lung cancer and report their clinical, ophtalmological and angiographic features. MATERIAL AND METHOD: 88 patients who in 1997 had been diagnosed of breast cancer (60 cases) and lung cancer (28) by the oncology unit in the University Hospital of Elche, underwent a thorough ophtalmological examination in search for choroidal metastases. Eighty six patients were newly diagnosed of cancer; the remaining two patients, in a complete remission status, relapsed during this period. RESULTS: Total prevalence of choroidal metastases in the sample was 4.54% (4 cases). Prevalence in lung cancer was 7.14% (2 cases) compared to 3.33% (2 cases) in breast cancer. Choroidal involvement was found in the following stages: 2 out of 7 patients (28.5%) in stage IV with disseminated breast cancer and 2 out of 9 patients (22.22%) in stage IV with disseminated lung cancer. CONCLUSIONS: Approximately one fourth of the patients showing disseminated breast and lung cancer (stage IV) showed metastases in the choroid. It appears from this study, that younger patients suffering from lung cancer are at greater risk of choroidal involvement (Arch Soc Esp Oftalmol 2002; 77: 23-28).