Infiltrados estériles tras cross-linking / Sterile infiltrates after cross-linking

Caso clínico: Mujer de 20 años que acude diagnosticada de queratocono bilateral asimétrico. Debido a las características topográficas y paquimétricas del queratocono del ojo derecho se decidió realizar la técnica de cross-linking. Tres días después del procedimiento, la paciente acude con unos infiltrados blanquecinos que resultaron ser estériles. Discusión: El cross-linking es una técnica eficaz a la par que segura. Sin embargo, en ocasiones pueden ocurrir ciertas complicaciones. Los infiltrados estériles han sido descritos aunque su procedencia sigue sin estar aclarada (AU)

Case report: A 20 year-old woman presented with an asymmetric bilateral keratoconus. Cross-linking of the right eye was performed due of its topographic and pachymetric conditions. Three days after the procedure, the patient presented with some corneal infiltrates that where classified as sterile. Discussion: Cross-linking is known for its efficacy and safety. Nevertheless, there can be complications. Sterile infiltrates have already been described, although their aetiology is still not clear (AU)

Sterile infiltrates after cross-linking. / Infiltrados estériles tras cross-linking.

CASE REPORT: A 20 year-old woman presented with an asymmetric bilateral keratoconus. Cross-linking of the right eye was performed due of its topographic and pachymetric conditions. Three days after the procedure, the patient presented with some corneal infiltrates that where classified as sterile. DISCUSSION: Cross-linking is known for its efficacy and safety. Nevertheless, there can be complications. Sterile infiltrates have already been described, although their aetiology is still not clear.

Post-surgical visual outcome and complications in Boston type 1 keratoprosthesis.

OBJECTIVE: To describe the visual outcome of patients who underwent Boston type 1 keratoprosthesis (KPro1) implantation, and describe serious sight-threatening post-operative complications. METHODS: We performed an analysis of the clinical records of all patients who underwent Boston keratoprosthesis implantation (BKI)in our institution from May 2006 to February 2011. RESULTS: A total of 41 eyes of 37 patients were included in the final analysis, of whom 22 (59.45%) were male and 15 were (40.54%) female. The mean age was 56.44 years (range 2-90). The most frequent diagnoses were bullous keratopathy, autoimmune diseases, such as Stevens-Johnson syndrome (SJS)/Lyell syndrome (LS), and aniridic keratopathy. The mean number of previous keratoplasties (PK) was 2.36 (range 0-8), the mean number of previous non-PK surgeries was 1.58 (range 0-9). The mean follow-up time was 22.17 months (range 3-46). The mean best corrected visual acuity (BCVA) logMAR before surgery was 2.05 (range 1.10-2.52), and the mean best corrected visual acuity achieved after surgery was 1.16 (range 0.08- 2.70). The most frequent complication was the formation of retroprosthetic membrane (RPM) which appeared in 22 (53.65%) eyes. Of these, 6 (27.27%) appeared after another surgery. Fourteen (63.63%) RPM required treatment, an average of 1.71 (range 1-4) laser YAG applications were performed, and surgical membranectomy was performed in 3 patients. Eleven (26.82%) eyes showed chorioretinal adhesion problems, 6 (14.63%) of which occurred after follow-up of BKI surgery. Infectious complications occurred in 7 (17.07%) cases; 2 (4.87%) patients had infectious keratitis and 5 (12.19%) endophthalmitis. CONCLUSIONS: Visual function improved in most patients. Those with prior multiple ocular surgeries and alterations of systemic immunity such as SJS, LS, and diabetes mellitus are at increased risk for serious sight-threatening complications, such as RPM, chorioretinal detachment and infection. Nevertheless, we consider KPro as an effective alternative in patients with multiple ocular pathology and imminent risk of rejection of a new KP.

Pronóstico visual y complicaciones posquirúrgicas en queratoprótesis de Boston tipo 1 / Post-surgical visual outcome and complications in Boston type 1 keratoprosthesis

Objetivo: Describir el resultado visual de los pacientes intervenidos de queratoprótesis de Boston tipo 1 (QB1), así como las complicaciones postoperatorias graves que afecten a la visión en estos pacientes. Métodos: Se realizó un análisis de los expedientes clínicos de todos los pacientes que recibieron QB1 en nuestra institución de mayo de 2006 hasta febrero de 2011. Resultados: Encontramos 41 ojos de 37 pacientes, 22 (59,45%) masculinos y 15 (40,54%) femeninos. La edad media fue de 56,44 años (rango 2-90). Los diagnósticos más frecuentes fueron la queratopatía ampollosa, enfermedades autoinmunes como el síndrome de Stevens-Johnson (SSJ)/síndrome de Lyell (SL) y queratopatía anirídica. El promedio de queratoplastias (QP) previas fue de 2,36 (rango 0-8) y el de cirugías oculares previas que no eran QP fue de 1,58 (rango 0-9). La media de seguimiento fue de 22,17 meses (rango 3-46). El promedio de la mejor agudeza visual corregida (MAVC) en escala de logMAR antes de la cirugía fue de 2,05 (rango 1,10-2,52) y la MAVC conseguida después de la cirugía fue de 1,16 (rango 0,08-2,70). La complicación más frecuente fue la formación de membrana retroprotésica (MRP), la cual apareció en 22 (53,65%) ojos. De estas, 6 (27,27%) fueron posteriores a otra cirugía. Requirieron tratamiento 14 (63,63%) MRP, un promedio de 1,71 (rango 1-4) aplicaciones de láser YAG y en tres pacientes membranectomía quirúrgica. En 11 (26,82%) ojos se presentaron problemas de adherencia coriorretinianos, seis (14,63%) de los cuales sucedieron después de otra cirugía posterior a la QB1. Complicaciones infecciosas se presentaron en siete (17,07%) casos, dos (4,87%) pacientes presentaron queratitis infecciosas y cinco (12,19%), endoftalmitis(AU)

Conclusiones: La función visual mejoró en la mayoría de pacientes. Aquellos con múltiples cirugías oculares previas y alteraciones de la inmunidad sistémica como SSJ, SL o diabetes mellitus (DM) presentan un mayor riesgo de presentar complicaciones graves que afecten a la visión, como MRP, desprendimientos coriorretinianos e infecciones. A pesar de todo, consideramos que es una alternativa efectiva en pacientes con enfermedad ocular múltiple e inminente riesgo de rechazo de una nueva QP(AU)

Objective: To describe the visual outcome of patients who underwent Boston type 1 keratoprosthesis (KPro1) implantation, and describe serious sight-threatening post-operative complications. Methods: We performed an analysis of the clinical records of all patients who underwent Boston keratoprosthesis implantation (BKI)in our institution from May 2006 to February 2011. Results: A total of 41 eyes of 37 patients were included in the final analysis, of whom 22 (59.45%) were male and 15 were (40.54%) female. The mean age was 56.44 years (range 2-90). The most frequent diagnoses were bullous keratopathy, autoimmune diseases, such as Stevens-Johnson syndrome (SJS)/Lyell syndrome (LS), and aniridic keratopathy. The mean number of previous keratoplasties (PK) was 2.36 (range 0-8), the mean number of previous non-PK surgeries was 1.58 (range 0-9). The mean follow-up time was 22.17 months (range 3-46). The mean best corrected visual acuity (BCVA) logMAR before surgery was 2.05 (range 1.10-2.52), and the mean best corrected visual acuity achieved after surgery was 1.16 (range 0.08- 2.70). The most frequent complication was the formation of retroprosthetic membrane (RPM) which appeared in 22 (53.65%) eyes. Of these, 6 (27.27%) appeared after another surgery. Fourteen (63.63%) RPM required treatment, an average of 1.71 (range 1-4) laser YAG applications were performed, and surgical membranectomy was performed in 3 patients. Eleven (26.82%) eyes showed chorioretinal adhesion problems, 6 (14.63%) of which occurred after follow-up of BKI surgery. Infectious complications occurred in 7 (17.07%) cases; 2 (4.87%) patients had infectious keratitis and 5 (12.19%) endophthalmitis(AU)

Conclusions: Visual function improved in most patients. Those with prior multiple ocular surgeries and alterations of systemic immunity such as SJS, LS, and diabetes mellitus are at increased risk for serious sight-threatening complications, such as RPM, chorioretinal detachment and infection. Nevertheless, we consider KPro as an effective alternative in patients with multiple ocular pathology and imminent risk of rejection of a new KP(AU)

[Interferon alpha 2ß, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma]. / Interferón alfa 2-ß, queratectomía parcial y trasplante de membrana amniótica para el tratamiento de un carcinoma escamoso conjuntival recidivante.

CASE REPORT: An 80-year-old woman diagnosed with a recurrent squamous conjuctival carcinoma treated with surgical excision of the lesion, zonal reconstruction and topical Interferon alpha 2-ß. DISCUSSION: Squamous conjunctival carcinoma is the most frequent neoplasm of the ocular surface. Surgical removal of the lesion is the traditional treatment, but this technique has a high recurrence rate. Interferons are glycoproteins that trigger intracellular pathways with antiviral and antitumoral properties. Recent studies have proven their activity against conjunctival carcinoma.

Interferón alfa 2-b, queratectomía parcial y trasplante de membrana amniótica para el tratamiento de un carcinoma escamoso conjuntival recidivante / Interferon alpha 2b, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma

Caso clínico: Mujer de 80 años de edad diagnosticada de carcinoma escamoso conjuntival recidivante tratado con escisión quirúrgica de la lesión, reconstrucción zonal e interferónalfa 2-b tópico. Discusión: La neoplasia escamosa de la conjuntiva y córnea es el tumor más frecuente dela superficie ocular. La cirugía mediante resección de la lesión es el método tradicional de tratamiento de estos tumores, pero presenta un elevado índice de recurrencias. La inmunoterapia es una alternativa actual para estos tumores. Los interferones son glicoproteínasque actúan activando una cascada de eventos intracelulares que confieren una actividad antivirales y antitumoral. Su actividad frente a las neoplasias epiteliales de la superficieocular se ha demostrado en los últimos años(AU)

Case report: An 80-year-old woman diagnosed with a recurrent squamous conjuctival carcinoma treated with surgical excision of the lesion, zonal reconstruction and topical Interferonalpha 2-b. Discussion: Squamous conjunctival carcinoma is the most frequent neoplasm of the ocularsurface. Surgical removal of the lesion is the traditional treatment, but this technique has a high recurrence rate. Interferons are glycoproteins that trigger intracellular path ways with antiviral and antitumoral properties. Recent studies have proven their activity againstconjunctival carcinoma(AU)

[Limbal stem cell deficiency following multiple intravitreal injections]. / Insuficiencia limbar secundaria a múltiples inyecciones intravítreas.

CASE REPORT: A 68 year-old male with idiopathic choroidal polypoidal vasculopathy received seven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developed a localized limbal stem cell deficiency which required limbal transplantation from the same eye. Two months after surgery, a slight improvement of visual acuity was noted, along with an intact ocular surface, clear cornea and decreased inflammation. DISCUSSION: Repeated surgical trauma on the limbus and surrounding areas may damage the limbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency. Repeated intravitreal injections may be considered as one of the possible causes.

Insuficiencia limbar secundaria a múltiples inyecciones intravítreas / Limbal stem cell deficiency following multiple intravitreal injections

Caso clínico: Varón de 68 años con vasculopatía polipoidea coroidea idiopática que requirió7 inyecciones intravítreas de bevacizumab en el cuadrante nasal-superior. Posteriormentedesarrolló una insuficiencia limbar localizada que requirió un autoinjerto limbar homolateral.A los dos meses de la cirugía, existía una discreta mejoría de la agudeza visual,observándose una córnea más transparente, un epitelio íntegro y una notable mejoría en laalteración de la superficie ocular.Discusión: Los traumatismos quirúrgicos repetidos sobre la región limbar o zonas próximas aella pueden ocasionar una alteración de las células madre limbares originando una epiteliopatíacorneal por insuficiencia limbar yatrogénica, entre cuyas causas deben considerarselas inyecciones intravítreas frecuentes(AU)

Case report: A 68 year-old male with idiopathic choroidal polypoidal vasculopathy receivedseven intravitreal injections of bevacizumab in the supero-nasal quadrant. He later developeda localized limbal stem cell deficiency which required limbal transplantation from thesame eye. Two months after surgery, a slight improvement of visual acuity was noted, alongwith an intact ocular surface, clear cornea and decreased inflammation.Discussion: Repeated surgical trauma on the limbus and surrounding areas may damage thelimbal stem cells, giving rise to a corneal epitheliopathy due to iatrogenic limbal deficiency.Repeated intravitreal injections may be considered as one of the possible causes(AU)

[The different opacity patterns of Lisch corneal dystrophy]. / Die verschiedenen Trübungsmuster der Lisch-Hornhautdystrophie.

BACKGROUND: Lisch corneal dystrophy is an epithelial corneal dystrophy where diffuse gray corneal opacifications are seen in direct illumination that appear in different patterns. Examination in retroillumination shows that these gray changes do consist of multiple densely crowded clear microcysts according to the opacity units. We wanted to investigate if one single case of Lisch corneal dystrophy can be differentiated easily from the other epithelial corneal dystrophies by exact analysis of the opacity units. PATIENTS AND METHODS: We examined three non-related patients with Lisch corneal dystrophy at the slit-lamp. The epithelial corneal opacities were documented photographically with direct slit-lamp illumination and retroillumination. RESULTS: All three patients showed the characteristic intraepithelial densely crowded clear microcysts in retroillumination. Diffuse gray radial opacities were noted in both corneas of a 15-year-old female patient. A club-shaped opacity was noted in one cornea of a 35-year-old female patient and a feathery gray opacity pattern was found in one cornea of a 49-year-old male patient. All three patients showed the characteristic densely crowded clear microcysts of Lisch corneal dystrophy in retroillumination. CONCLUSION: Taking the previous literature into account, five different opacity patterns can be summarised: radial, band, flame/feathery, whorled and club-shaped gray epithelial corneal opacities. A single case of Lisch corneal dystrophy can be differentiated from other epithelial corneal dystrophies by means of an exact analysis of the opacity pattern and units by slit-lamp examination.

Fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution for inflammation after cataract surgery: a randomized, comparative, active treatment-controlled trial.

PURPOSE: To assess the efficacy, tolerance, and ocular tolerability of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution compared with 0.1% diclofenac (Voltaren) and 0.3% tobramycin (Tobrex) in patients undergoing cataract extraction by either nuclear expression (extracapsular) or ultrasound-assisted aspiration (phacoemulsification) with intraocular lens implantation. METHODS: Eighty-eight patients undergoing cataract extraction with intraocular lens implantation participated in a randomized, parallel, observer-masked trial, in which the clinical usefulness of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution, two eyedrops every 6 hours (n = 44) was compared with Voltaren and Tobrex, one drop of each every 6 hours (n = 44) in a 22-day course. Efficacy was assessed from changes of the sum of anterior chamber cell count plus flare, conjunctival hyperemia and edema, and ciliary congestion, by means of slit lamp biomicroscopy on days 1, 7, 14, and 21. Tolerance and ocular tolerability were assessed by recording intraocular pressure (IOP), side effects, and the patient's and investigator's opinions. RESULTS: Anterior chamber cell count plus flare showed no differences in the two treatment groups at any evaluation point. The study treatment was associated with a significantly higher score for conjunctival edema on day 1 (p = 0.015), conjuncitval hyperemia on day 14 (p = 0.009) and anterior chamber cell count on day 21 (p = 0.04), but these differences had no clinical relevance. No side effects related to the study treatment were recorded. CONCLUSIONS: Efficacy, tolerance, and ocular tolerability of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution were comparable to Voltaren plus Tobrex for the control of anterior chamber inflammation after cataract surgery, with the advantage that both active principles are supplied in a single container.

Storage, surgery, outcome, complications, and new developments in corneal and conjunctival grafts.

This review covers last year's literature on corneal, limbal, and conjunctival transplantation including tissue storage and eye banking. In this area, the main themes were related to a better evaluation of tissue viability and the exclusion of disease transmission. An analysis of the changing indications for penetrating keratoplasty shows the differences between American and European series. Most efforts in relation to surgical techniques are oriented toward obtaining better refractive results, whereas the study of large series sheds new light on the risk factors for graft failure and other complications. Limbal transplants have acquired the status of a new field in the surgical treatment of ocular surface disease, particularly in relation to corneal stem cell deficiencies.