Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch / Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy

CASO CLÍNICO: Presentamos el caso de una mujer de 64 años con agudeza visual de 20/40 en su ojo derecho, debida a una opacificación grisácea y plumosa con microquistes en el epitelio corneal, compatible con una distrofia epitelial de Lisch. Se trató secuencialmente con varios desbridamientos epiteliales, lente de contacto y mitomicina C, a pesar de los cuales, recidivaba. La extirpación de un sector limbar y el trasplante de limbo autólogo obtuvieron buenos resultados y sin recurrencia. CONCLUSIÓN: El trasplante autólogo de limbo tras extirpar la zona de limbo afectado puede ser considerado como una nueva opción terapéutica en el tratamiento de la distrofia epitelial de Lisch asimétrica, cuando otros tratamientos han fallado

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. Conclusions: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed

Keratolimbal autograft transplantation as a possible new treatment of Lisch epithelial corneal dystrophy. / Trasplante autólogo de limbo como nuevo tratamiento de la distrofia corneal epitelial de Lisch.

CASE REPORT: The case concerns 64-year-old woman with visual acuity of 20/40 in the right eye. Slit-lamp examination revealed a grey, feathery corneal opacification with intraepithelial microcysts compatible with Lisch epithelial corneal dystrophy (LECD). It was treated with epithelial debridements, contact lenses and mitomycin C, but the opacification recurred within months. The removal of limbus sector and autologous limbal transplantation (KLAT) were used successfully without recurrence. CONCLUSIONS: After removal of damaged limbus, KLAT should be considered as a treatment option for asymmetric LECD when other treatments have failed.

Keratitis caused by Absidia corymbifera in an immunocompetent male with no corneal injuries.

Case Report A healthy 55-years-old male went to emergency due to a white infiltrate in the left eye without corneal trauma which partially responds to antibiotic treatment. The infiltrate worsened by the use of topical steroids. Direct microscopic evaluation and Gram stain are a valuable diagnostic tool for the detection of Absidia filaments. There is a successful treatment with anphotericin and posaconazole. Discussion Keratitis caused by Zygomicetes are unusual. This is a rare condition in healthy patients with no corneal trauma. The treatment with amphotericin and posaconazole are synergistic against filamentous fungi.

Amblyopia secondary to iris cyst.

CLINICAL CASE: A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION: The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.

Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK / Relationship between donor-receptor interface and visual acuity in DSAEK

Objetivo: Evaluar la relación entre la agudeza visual (AV) mejor corregida y la interfase donante-receptor resultante tras realizar una queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK). Métodos: Se revisaron 46 historias clínicas de pacientes intervenidos con técnica DSAEK, de las cuales cumplían criterios de inclusión 22 pacientes (dos de ellos con DSAEK bilateral). Todos ellos fueron intervenidos por un mismo oftalmólogo desde enero del 2010 hasta abril del 2011. Las indicaciones quirúrgicas fueron: queratopatía bullosa 19 (72,2%), distrofia endotelial de Fuchs tres (12,5%) y agotamiento endotelial tras queratoplastia previa dos (8,3%).Se recogió la AV preoperatoria y al tercer y sexto mes postoperatorio, comparándose en estas dos últimas la interfase existente entre donante y receptor tras DSAEK medida en cámara Scheimpflug de topógrafo corneal (Pentacam-HR, Oculus®, Wetzlar, Alemania). Resultados: Tras la cirugía con DSAEK, la mejora en la AV fue en 19 ojos al tercer mes y en 20 ojos al sexto mes postoperatorio (p < 0,001). Dicho cambio en la AV se comparó con la disminución de la densidad óptica de la interfase donante-receptor resultante, encontrando una relación positiva y significativa entre estas (Rho interfase 3 meses y cambio de AV 6 meses: 0,44; p < 0,001). Sin embargo, la interfase se relacionó negativa y significativamente con la AV (Rho 3 m: –0,41; p = 0,045). Además, los pacientes que presentaban un estroma más denso conseguían AV postoperatorias peores en términos relativos si se comparaban con los que presentaban un estroma menos dañado. Conclusiones: Los pacientes sometidos a DSAEK con AV prequirúrgicas peores experimentan una mejora visual mayor en valores absolutos y, sin embargo, alcanzarían una AV menor relativa que se podría relacionar con una interfase más refringente, como consecuencia de un estroma corneal preoperatorio más alterado (AU)

Objective: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). Methods: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty.The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam® model). Results: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P < 0.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P <0 .001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: –0.41, P = 0.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. Conclusions: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma (AU)

[Relationship between donor-receptor interface and visual acuity in DSAEK]. / Relación entre la interfase donante/receptor y la agudeza visual en trasplante corneal tipo DSAEK.

OBJECTIVE: To evaluate the relationship between best corrected visual acuity and donor-recipient interface resulting after Descemet's Stripping with Automated Endothelial Keratoplasty (DSAEK). METHODS: Retrospective review of 46 clinical histories after DSAEK intervention in which 22 patients who fulfilled the inclusion criteria (two with bilateral DSAEK), were studied. All were operated on by the same ophthalmologist from January 2010 until April 2011. Surgical indications were: 19 (72.2%) bullous keratopathy, 3 (12.5%) Fuchs endothelial dystrophy, and 2 (8.3%) previous failed keratoplasty. The visual acuity (VA) was recorded preoperatively, and at three and six months after the operation; the latter two being compared with the interface between donor and recipient after DSAEK measured in a Scheimpflug corneal topography camera (Pentacam(®) model). RESULTS: After DSAEK surgery 19 eyes had improved visual acuity at three months, and 20 eyes at six months (P<.001). This improvement was compared with the decrease in optical density of the resulting donor-receptor interface, with apositive and significant relationship being found between them (Rho interface 3 months, and improved AV 6 months 0.44, P<.001). However, the interface is negatively and significantly related with visual acuity (Rho 3 m: -0.41, P=.045). Also, patients who had a denser stroma had a worse postoperative visual acuity in relative terms when compared with those who had a less damaged stroma. CONCLUSIONS: Patients undergoing DSAEK with worse preoperative visual acuity had a greater improvement visual in absolute values and however, they may have achieved a lower relative visual acuity than could be related to a higher refractive interface, as a result of a more damaged preoperative corneal stroma.

[Corneal toxicity due to amantadine]. / Toxicidad corneal por amantadina.

CASE REPORT: A 64 year-old female with Parkinson disease treated with amantadine for two years who suddenly suffered bilateral corneal oedema. It was initially treated as herpetic endotheliitis without improvement as we lacked information on her chronic treatment. The corneal oedema finally resolved after withdrawing the drug. DISCUSSION: Amantadine hydrochloride may produce endothelial dysfunction. Once the amantadine treatment is stopped, the corneal oedema may be reversible but endothelial density remains low. An ophthalmologist examination should be performed before the initiation of amantadine treatment in order to establish a risk: benefit ratio, especially in those patients with low endothelial density or any endothelial anomaly.