Progresión en glaucoma. Guía de práctica clínica / Glaucoma progression. Clinical practice guide

Objetivo Ofrecer una serie de recomendaciones generales que sirvan de orientación en la evaluación y el manejo de la progresión glaucomatosa en la práctica clínica diaria a partir de la evidencia clínica de calidad existente. Métodos Tras la definición de los objetivos y del alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Una vez evaluada toda la evidencia clínica existente con las herramientas AMSTAR2 (Assessment of Multiple systematic Rewiews) y Risk of bias de Cochrane de forma independiente por al menos dos revisores, se pasó a la formulación de recomendaciones siguiendo la metodología del Scottish Intercollegiate Guideline Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección y el seguimiento de la progresión glaucomatosa con los distintos métodos disponibles y para el tratamiento de los pacientes. Conclusiones A pesar de que para muchas de las preguntas el nivel de evidencia científica disponible no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de los diferentes aspectos existentes relacionados con la evaluación y el manejo de la progresión glaucomatosa (AU)

Objective To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR2 (Assessment of Multiple Systematic Reviews) and Cochrane «Risk of bias» tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. Results Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression (AU)

Glaucoma progression. Clinical practice guide.

OBJECTIVE: To provide general recommendations that serve as a guide for the evaluation and management of glaucomatous progression in daily clinical practice based on the existing quality of clinical evidence. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple Systematic Reviews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate Guideline network (SIGN) methodology. RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the interpretation and decision-making related to the different methods for the detection of glaucomatous progression are presented. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of glaucomatous progression.

Vitrectomy combined with posterior-segment Ahmed valve implant: A case series study.

PURPOSE: To analyze the surgical outcomes and complication rates in a group of patients with refractory glaucoma who underwent simultaneous pars plana vitrectomy (PPV) and PC7 or PC8 Ahmed glaucoma valve (AGV) implantation. METHODS: Retrospective case series study of 10 eyes in 9 patients with secondary glaucoma, refractory to other treatment, who underwent 23G-PPV and implantation of PC7 or PC8 AGV between 2012 and 2014. Study variables were postoperative BCVA, IOP and the number of glaucoma medications, which were evaluated preoperatively and at 1 day, 1 week and 1, 3, 6, and 12 months after the surgical intervention. Absolute success was defined as IOP less than 21 mmHg in the absence of any medication and qualified success if medication was needed to control IOP under 21 mmHg. RESULTS: The average follow-up was 10.2 ±â€¯2.89 months. Postoperative IOP levels decreased in all cases in comparison with preoperative values (p < 0.05). Absolute success rate was 60%, reaching 100% in terms of qualified success. Kaplan-Meier survival analysis showed 60% absolute success at 12 months. Changes in postoperative BCVA were not statistically significant in comparison with preoperative data. Early postoperative complications were athalamia, hyphema, and retinal detachment; late complications were pars plana clip extrusion and cystic bleb. CONCLUSIONS: PC7 and PC8 Ahmed valve implantation via pars plana is a safe and useful option in patients with secondary refractory glaucoma who are either candidates for PPV or have been previously vitrectomized.

Guía de estilos de vida y glaucoma (i). Deporte y actividades / Lifestyles guide and glaucoma (i). Sports and activities

Objetivos: El aumento de la calidad y de la esperanza de vida y el hecho de que el glaucoma se diagnostique cada vez más precozmente hace preguntarse a muchos pacientes si afectan a su enfermedad determinados deportes, actividades o aficiones. El objetivo de este trabajo es establecer unas guías para aconsejar a los pacientes con base en la evidencia científica de los trabajos publicados. Métodos: Revisión de todos los trabajos publicados sobre glaucoma y deportes u otras actividades. Los trabajos fueron clasificados según el nivel de evidencia científica basada en la clasificación del Oxford Centre for Evidence-Based Medicine. Resultados: Las actividades aeróbicas son beneficiosas para el paciente. Se han de evitar deportes o técnicas de relajación tipo yoga con maniobras de Valsalva o colocación de la cabeza en posición inferior. También se deben evitar los cambios bruscos en altura. El calor intenso no parece influir en el glaucoma, pero el frío intenso puede afectar a pacientes con disregulación vascular. Las actividades de visión próxima disminuyen levemente la presión intraocular. El uso de instrumentos de viento puede elevar la presión intraocular dependiendo de la técnica utilizada. Conclusiones: Ciertos deportes y actividades pueden tener una influencia en la aparición o la progresión del glaucoma. Los especialistas en glaucoma deben tener información adecuada sobre la evidencia científica de las publicaciones para poder aconsejar apropiadamente a los pacientes (AU)

Purposes: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. Results: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. Conclusions: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients (AU)

Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial / Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension

Objetivos: Establecer guías para aconsejar a los pacientes respecto a la relación entre dieta y hábitos de vida y glaucoma. Métodos: Revisión de los trabajos publicados sobre glaucoma y la dieta, la ingesta de suplementos, el consumo de drogas o el tabaco, el sueño, el embarazo y la hipertensión. Los trabajos fueron clasificados según el Oxford Center for Evidence-Based Medicine. Resultados: La evidencia sobre la relación entre la dieta o el uso de suplementos y la incidencia o la progresión del glaucoma es insuficiente para justificar una recomendación. Si bien algunos estudios en glaucoma de tensión normal sugieren que el Ginkgo biloba podría reducir la progresión, no permiten recomendar su uso generalizado. Los estudios sobre tabaco no demuestran claramente una relación entre consumo de tabaco e incidencia del glaucoma. La marihuana no es un tratamiento útil para el glaucoma. Los resultados sobre la relación entre la apnea del sueño y glaucoma son heterogéneos, pero sí parece conveniente que los pacientes con grado moderado o severo de apnea sean evaluados para descartar glaucoma. El embarazo no suele afectar al curso de la enfermedad, pero varios medicamentos hipotensores pueden ser nocivos para el feto. La hipotensión nocturna es un factor de riesgo de empeoramiento del glaucoma. Conclusiones: Ciertas costumbres, circunstancias o enfermedades pueden tener una influencia en la aparición o progresión del glaucoma. Es importante conocer la evidencia científica existente para poder aconsejar adecuadamente a los pacientes (AU)

To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. Methods: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. Results: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. Conclusions: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients (AU)

Lifestyles guide and glaucoma (i). Sports and activities. / Guía de estilos de vida y glaucoma (i). Deporte y actividades.

PURPOSES: The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. RESULTS: Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva manoeuvres are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. CONCLUSIONS: Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients.

Lifestyles guide and glaucoma (II). Diet, supplements, drugs, sleep, pregnancy, and systemic hypertension. / Guía de estilos de vida y glaucoma (II). Dieta, suplementos, drogas, sueño, embarazo e hipertensión arterial.

PURPOSE: To establish evidence based guidelines to advise patients on the relationship between habits, diet, certain circumstances, diseases and glaucoma. METHODS: Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-based Medicine classification. RESULTS: The evidence on the relationship between diet or supplements and the incidence or progression of glaucoma is insufficient to make a general recommendation for glaucoma patients. Although some studies on normal tension glaucoma suggest that Gingko biloba could reduce glaucoma progression, the results do not allow a general recommendation for all these patients. Similarly, the evidence on the usefulness of vitamin supplements is not conclusive. The studies on smoking do not clearly demonstrate the relationship between this habit and incidence of glaucoma. Marihuana is not a useful treatment for glaucoma. Although the results on the relationship between sleep apnoea and glaucoma are heterogeneous, it is recommended that patients with moderate to intense apnoea are tested for glaucoma. Pregnancy does not influence the course of the disease, but several hypotensive drugs may be harmful for the foetus. Nocturnal systemic hypotension is a risk factor for glaucoma progression. CONCLUSIONS: Certain habits, circumstances, or diseases may have an influence on the onset or progression of glaucoma. It is important to have adequate information about the scientific evidence in the publications in order to properly advise patients.

Síndrome de aumento agudo idiopático de mancha ciega asociado a neovascularización coroidea / Acute idiopathic blind spot enlargement syndrome associated with choroidal neovascularization

Caso clínico: Mujer de 17 años que consulta por fotopsias y escotoma en OI, con antecedente de neovascularización coroidea contralateral. La exploración sugiere un síndrome de aumento agudo idiopático de mancha ciega. La evolución sin tratamiento es favorable, con disminución del escotoma y sin empeoramiento de su agudeza visual. Discusión: El síndrome de aumento agudo idiopático de mancha ciega es un síndrome raro y benigno, propio de mujeres jóvenes. Se debe hacer un diagnóstico diferencial con el síndrome de puntos blancos evanescentes y la retinopatía aguda zonal externa oculta. Tras revisar la bibliografía, no hemos hallado ningún caso descrito previamente en asociación con la neovascularización coroidea, hecho que nos obliga a cuestionarnos su benignidad (AU)

Clinical case: A 17 year old female consulting due to photopsia and a sudden loss of visual field in left eye (OS), with previous contralateral choroidal neovascularization. The examination suggested an acute idiopathic blind spot syndrome. The progress without treatment was favorable, with a reduction in the scotoma and without a worsening of her visual acuity. Discussion: This case report is about an unusual and benign syndrome, typical of young women. Differential diagnosis must be made between the evanescent white dot syndrome and the acute zonal occult outer retinopathy. To our knowledge, this is the first published case associated with choroidal neovascularization, a fact that leads us to question its benignancy (AU)

[Acute idiopathic blind spot enlargement syndrome associated with choroidal neovascularization]. / Síndrome de aumento agudo idiopático de mancha ciega asociado a neovascularización coroidea.

CLINICAL CASE: A 17 year old female consulting due to photopsia and a sudden loss of visual field in left eye (OS), with previous contralateral choroidal neovascularization. The examination suggested an acute idiopathic blind spot syndrome. The progress without treatment was favorable, with a reduction in the scotoma and without a worsening of her visual acuity. DISCUSSION: This case report is about an unusual and benign syndrome, typical of young women. Differential diagnosis must be made between the evanescent white dot syndrome and the acute zonal occult outer retinopathy. To our knowledge, this is the first published case associated with choroidal neovascularization, a fact that leads us to question its benignancy.

Changes in tear protein profile in keratoconus disease.

PURPOSE: To analyze tear protein profile variations in patients with keratoconus (KC) and to compare them with those of control subjects. SUBJECTS AND METHODS: Tears from 12 normal subjects and 12 patients with KC were analyzed by two-dimensional gel electrophoresis (2-DE) and liquid chromatography-mass spectrometry (LC-MS). Analysis of the 2-DE gels was performed using Progenesis SameSpots software (Nonlinear Dynamics). Proteins exhibiting high variation in expression levels (P-value <0.05) were identified using matrix-assisted laser desorption/ionization-TOF spectrometry. For LC-MS analysis, a label-free quantification approach was used. Tears were digested with trypsin, subjected to data-independent acquisition (MS(E)) analysis, and identified proteins were relatively quantified using ProteinLynx Global Server software (Waters). RESULTS: The 2-DE and LC-MS analyses revealed a significant decrease in the levels of members of the cystatin family and an increase in lipocalin-1 in KC patients. A 1.43-fold decrease was observed for cystatin-S by 2-DE, and 1.69- and 1.56-fold for cystatin-SN and cystatin-SA by LC-MS, respectively. The increase in lipocalin-1 was observed by both methods with fold changes of 1.26 in the 2-DE approach and 1.31 according to LC-MS. Significant protein upregulation was also observed for Ig-κ chain C and Ig J chain proteins by 2-DE. Levels of lipophilin-C, lipophilin-A, and phospholipase A2 were decreased in tears from KC patients according to LC-MS. Serum albumin was found to be increased in KC patients according to LC-MS. CONCLUSION: The results show differences in the tear protein profile of KC and control subjects. These changes are indicative of alterations in tear film stability and in interactions with the corneal surface in KC patients.

Influencia del LASIK en la capa de fibras nerviosas retinianas / Influence of LASIK on retinal nerve fiber layer

Objetivo: Estudiar la influencia de la queratomileusis asistida por láser (LASIK) en el grosor de capa de fibras nerviosas retinianas (CFNR). Métodos: 50 ojos miopes tratados mediante LASIK sin complicaciones. Medición de espesor de CFNR peripapilar preoperatorio y postoperatorio (2 semanas) mediante tomografía óptica de coherencia (OCT). Variables: grosor medio, superior, inferior, nasal y temporal. Comparación estadística entre valores preoperatorios y postoperatorios. Estudio de correlación entre el grado de miopía y el espesor de CFNR. Resultados: No existieron diferencias estadísticas significativas entre los valores preoperatorios y postoperatorios de grosor de CFNR en ninguna las variables estudiadas: espesor medio (77,6 DE 14 vs 81 DE 13,3), superior (103,1 DE 22,6 vs 105,4 DE 24,6), inferior (89,3 DE 28 vs 93,9 DE 23,1), nasal (53,7 DE 18,1 vs 56,1 DE 16) y temporal (64,74 DE 12,29 vs 67,3 DE 13,7) (P > 0,05 en todas las comparaciones; t de Student). Se demostró una correlación inversa entre el grado de miopía y el grosor de CFNR en todas las variables estudiadas: espesor medio (r= –0,45), superior (r= –0,42), inferior (r= –0,39), nasal (r= –0,26) y temporal (r= –0,09) (test de Pearson). Conclusiones: El espesor de CFNR medido mediante OCT no se afecta por el LASIK en el periodo de seguimiento(AU)

Purpose: Objective: To study the influence of laser-assisted in situ keratomileusis (LASIK) on retinal nerve fibre layer (RNFL) thickness. Methods: 50 myopic eyes treated with uncomplicated LASIK. Measurement of preoperatory and postoperatory (2 weeks) peripapillary RNFL thickness by optical coherence tomography (OCT). Study variables: mean, superior, inferior, nasal and temporal thickness. Statistical comparison between preoperatory and postoperatory values. Study of the correlation between the amount of myopia and RNFL thickness. Results: There were no statistical differences between preoperatory and postoperatory RNFL thickness values in any of the studied variables: mean (77.6 SD 14 vs 81 SD 13,3), superior (103.1 SD 22,6 vs 105.4 SD 24.6), inferior (89.3 SD 28 vs 93.9 SD 23.1), nasal (53.7 SD 18.1 vs 56.1 SD 16) and temporal thickness (64.74 SD 12.29 vs 67.3 SD 13.7) (P > 0.05 for all comparisons; Student's t test). There was an inverse correlation between the amount of myopia and RNFL thickness in all of the studied variables: mean (r=-0.45), superior (r=-0.42), inferior (r=-0.39), nasal (r=-0.26) and temporal thickness (r= -0.09) (Pearson's test). Conclusions: OCT-measured RNFL thickness remains unchanged after LASIK in the follow-up period(AU)

[Influence of LASIK on retinal nerve fiber layer]. / Influencia del LASIK en la capa de fibras nerviosas retinianas.

OBJECTIVE: To study the influence of laser-assisted in situ keratomileusis (LASIK) on retinal nerve fibre layer (RNFL) thickness. METHODS: 50 myopic eyes treated with uncomplicated LASIK. Measurement of preoperatory and postoperatory (2 weeks) peripapillary RNFL thickness by optical coherence tomography (OCT). STUDY VARIABLES: mean, superior, inferior, nasal and temporal thickness. Statistical comparison between preoperatory and postoperatory values. Study of the correlation between the amount of myopia and RNFL thickness. RESULTS: There were no statistical differences between preoperatory and postoperatory RNFL thickness values in any of the studied variables: mean (77.6 SD 14 vs 81 SD 13,3), superior (103.1 SD 22,6 vs 105.4 SD 24.6), inferior (89.3 SD 28 vs 93.9 SD 23.1), nasal (53.7 SD 18.1 vs 56.1 SD 16) and temporal thickness (64.74 SD 12.29 vs 67.3 SD 13.7) (P > 0.05 for all comparisons; Student's t test). There was an inverse correlation between the amount of myopia and RNFL thickness in all of the studied variables: mean (r= -0.45), superior (r= -0.42), inferior (r=-0.39), nasal (r= -0.26) and temporal thickness (r= -0.09) (Pearson's test). CONCLUSIONS: OCT-measured RNFL thickness remains unchanged after LASIK in the follow-up period.

[Study of two immunosuppresive strategies after limbal allograft transplantation]. / Estudio de dos pautas de inmunosupresión tras alotrasplante límbico.

PURPOSE: Comparison of two immunosuppressive strategies after limbal allograft transplantation in an experimental model of ocular surface chemical burn. METHODS: Twenty albino rabbits underwent corneal and limbal chemical burn with NaOH. One week later limbal transplantation was performed. Clinical assessments included measurements of epithelial defect, stromal opacity and neovascularization areas, using a computerized planimetry system 0, 7, 15, 30, 60 and 90 days after the chemical burn. Histologic examination was performed at 3 months, after sacrifice of the animals. Two immunosuppressive strategies were evaluated: topical cyclosporin A on constant dosage (group 1), and a combination of topical cyclosporin A and dexamethasone followed by a tapered dosage of topical cyclosporin A (group 2). RESULTS: No statistical differences were observed between both groups regarding all of the variables 3 months after the chemical burn. Differences in the stromal opacity area were detected on day 7 (43.33 D.E. 4.84 vs 36.67 D.E. 3.88; p<0.01), day 15 (41.68 3 D.E.95 vs 33.6 D.E. 1.99; p<0.01), and day 30 (40.1 D.E. 5.45 vs 32.52 D.E. 7.33; p<0.05). As for the neovascularization area, differences were detected on day 7 (1.92 D.E. 0.48 vs 3.73 D.E. 1.18; p<0.01), day 15 (7.08 D.E. 1.54 vs 4.42 D.E. 1.68; p<0.01), and day 60 (4.9 D.E. 2.58 vs 9.65 D.E. 5.55; p<0.05). CONCLUSIONS: There are no long-term differences between both immunosuppressive strategies regarding all the studied variables (Arch Soc Esp Oftalmol 2003; 78: 29-34).

Estudio de dos pautas de inmunosupresión tras alotrasplante límbico / Study of two immunosuppresive strategies after limbal allograft transplantation

Objetivo: Comparación de dos pautas de inmunosupresión tras alotrasplante límbico en un modelo de causticación experimental de la superficie ocular. Métodos: 20 conejos albinos, sometidos a causticación corneal con compromiso limbar con NaOH y alotrasplante límbico al cabo de una semana. Las determinaciones clínicas consistieron en la medición del área de defecto epitelial, opacidad estromal y neovascularización corneal, mediante planimetría computerizada en los días 0, 7, 15, 30, 60 y 90 tras la causticación. El estudio histológico se realizó a los 3 meses, tras sacrificio de los animales. Se evaluaron dos pautas de inmunosupresión: ciclosporina A tópica a dosis constante (grupo 1) y una combinación inicial de dexametasona y ciclosporina A tópicas, seguida por una pauta descendente de ciclosporina A (grupo 2). Resultados: No se encontraron diferencias estadísticas entre ambos grupos a los 3 meses en ninguna de las variables. Se detectaron diferencias en el área de opacidad estromal en los días 7 (43,33 D.E. 4,84 vs 36,67 D.E. 3,88; p<0,01), 15 (41,68 D.E. 3,95 vs 33,6 D.E. 1,99; p<0,01), y 30 (40,1 D.E. 5,45 vs 32,52 D.E. 7,33; p<0,05). En cuanto al área de neovascularización, se detectaron diferencias en los días 7 (1,92 D.E. 0,48 vs 3,73 D.E. 1,18; p<0,01), 15 (7,08 D.E. 1,54 vs 4,42 D.E. 1,68; p<0,01), y 60 (4,9 D.E. 2,58 vs 9,65 D.E. 5,55; p<0,05). Conclusiones: No existen diferencias a largo plazo entre ambas pautas de inmunosupresión en las variables estudiadas (AU)

Purpose: Comparison of two immunosuppressive strategies after limbal allograft transplantation in an experimental model of ocular surface chemical burn. Methods: Twenty albino rabbits underwent corneal and limbal chemical burn with NaOH. One week later limbal transplantation was performed. Clinical assessments included measurements of epithelial defect, stromal opacity and neovascularization areas, using a computerized planimetry system 0, 7, 15, 30, 60 and 90 days after the chemical burn. Histologic examination was performed at 3 months, after sacrifice of the animals. Two immunosuppressive strategies were evaluated: topical cyclosporin A on constant dosage (group 1), and a combination of topical cyclosporin A and dexamethasone followed by a tapered dosage of topical cyclosporin A (group 2). Results: No statistical differences were observed between both groups regarding all of the variables 3 months after the chemical burn. Differences in the stromal opacity area were detected on day 7 (43.33 D.E. 4.84 vs 36.67 D.E. 3.88; p<0.01), day 15 (41.68 3 D.E..95 vs 33.6 D.E. 1.99; p<0.01), and day 30 (40.1 D.E. 5.45 vs 32.52 D.E. 7.33; p<0.05). As for the neovascularization area, differences were detected on day 7 (1.92 D.E. 0.48 vs 3.73 D.E. 1.18; p<0.01), day 15 (7.08 D.E. 1.54 vs 4.42 D.E. 1.68; p<0.01), and day 60 (4.9 D.E. 2.58 vs 9.65 D.E. 5.55; p<0.05). Conclusions: There are no long-term differences between both immunosuppressive strategies regarding all the studied variables (AU)