Infectious keratitis associated with contact lens wear: REGINFECOR multicenter study.

This 32-centre multicentre study addresses the lack of knowledge about the prevalence and significance of microbial keratitis (MK) associated with contact lens (CL) wear in Spain. A total of 304 cases recruited from 32 hospitals were studied and showed that infectious keratitis associated with contact lens wear mainly affects young women during the summer months. In this study, soft lenses with monthly replacement and single solution cleaning were most commonly used, purchased and fitted in opticians' shops. Common risk factors were identified among users, such as topping off solutions, prolonging the life of lenses, and frequently sleeping, swimming and showering with lenses. Overnight lens wear was significantly associated with a higher incidence of corneal opacities, and the presence of Pseudomonas aeruginosa in bacterial cultures was associated with more severe sequelae and a greater need for corneal transplantation. Although most cases were benign, the time taken to heal was long, which poses a problem for working patients. This study provides valuable epidemiological, microbiological and risk factor information and estimates the incidence of CL related MK in Spain to be approximately 1 case per 30,000 inhabitants per year.

Achromobacter xylosoxidans keratitis in a LASIK flap treated with intrastromal antibiotics: a case report.

Intrastromal antibiotic injections are a type of treatment that can be very useful in bacterial keratitis refractory to topical antibiotics. We present the case of a 44-year-old woman with an infiltrate in a laser in situ keratomiuleusis (LASIK) flap and growth of Achromobacter xylosoxidans, who was treated with topical ceftazidime for 1 month. However, after discontinuation of the antibiotic, there was a worsening with growth of the same germ. Topical treatment was reintroduced and, due to suspicion of germ reservoir, it was decided to give three cycles of intrastromal ceftazidime injections, the last one also with moxifloxacin, with good results. After 4 months asymptomatic and without treatment at the moment, no signs of recurrence have been observed. This case supports the usefulness of intraestromal injections in refractory cases to the topical medication.

Afectación ocular secundaria a la infección por Monkeypox virus / Ocular involvement secondary to Monkeypox virus infection

Presentamos el caso de un paciente varón de 37años con cuadro compatible con conjuntivitis adenovírica de 5días de evolución. Se pautaron corticoides tópicos, lubricantes y retirada de pseudomembranas. El análisis mediante PCR del exudado conjuntival resultó positivo para Monkeypox virus. Durante el seguimiento presentó úlceras corneales de evolución tórpida, por lo que precisó ingreso para instaurar tratamiento con tecovirimat. La afectación ocular por Monkeypox virus suele ser leve y autolimitada. Se han descrito casos con afectación visual severa cuando hay daño corneal, tal y como se ejemplifica en este caso. Tras el ingreso hospitalario para tratamiento sistémico, presentó una evolución favorable. (AU)

We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5days’ evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably. (AU)

Ocular involvement secondary to Monkeypox virus infection.

We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5 days' evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with Tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably.

Insulina colirio en afecciones de la superficie ocular

Cuando se produce una erosión corneal y fracasa la epitelización corneal surgen los defectos epiteliales corneales persistentes, cuyo tratamiento es un desafío para el oftalmólogo. Es muy frecuente el fracaso del tratamiento convencional por lo que se mantiene el interés en la búsqueda de otros factores de crecimiento para la cicatrización epitelial tales como los colirios de insulina. La insulina es un péptido estrechamente relacionado con el factor de crecimiento similar a la insulina 1. Su mecanismo de acción no es bien comprendido, sin embargo se acepta que es capaz de inducir migración y proliferación de las células epiteliales corneales, por lo que promueve y acelera la reepitelización de defectos epiteliales persistentes refractarios a tratamiento. La ausencia de una presentación comercial de colirio de insulina, hace necesario conocer su estabilidad físicoquímica y microbiológica así como la eficacia, efectividad y seguridad del colirio de insulina a diferentes concentraciones. De ahí la motivación para realizar una revisión de la literatura existente sobre el empleo del colirio de insulina en el tratamiento del defecto epitelial corneal persistente. Se realizó la búsqueda en bases de datos electrónicas como PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID con el objeto de identificar artículos relacionados con el tema.

When corneal erosion occurs and corneal epithelialization fails, persistent corneal epithelial defects arise, whose treatment is a challenge for the ophthalmologist. The failure of conventional treatment is very frequent; therefore, there is still interest in the search for other growth factors for epithelial healing, such as insulin eye drops. Insulin is a peptide closely related to insulin-like growth factor 1. Its mechanism of action is not well understood; however, it is accepted that it is capable of inducing migration and proliferation of corneal epithelial cells, thereby promoting and accelerating reepithelialization of persistent epithelial defects refractory to treatment. The absence of a commercial presentation for insulin eye drops makes it necessary to know its physicochemical and microbiological stability, as well as the efficacy, effectiveness and safety of insulin eye drops at different concentrations; hence the motivation to review the existing literature on the use of insulin eye drops in the treatment of persistent corneal epithelial defects. The search was carried out in electronic databases such as PubMed Central, EBSCO, Clinical Trials.gov, MEDLINE OVID, EMBASE OVID, with the aim of identifying relevant articles related to the topic.

Queratouveítis y conjuntivitis causadas por Euphorbia ingens. Revisión de un caso / Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review

Euphorbia ingens es una planta ubicua, que contiene una savia lechosa. Puede accidentalmente dañar los ojos de los humanos por su naturaleza cáustica, causando conjuntivitis, queratitis, uveítis, estafiloma anterior y cicatrización corneal en pacientes no tratados. Presentamos el caso de un paciente cuyo ojo entró en contacto con esta savia lechosa, causándole conjuntivitis, defecto epitelial corneal y uveítis. Después de un tratamiento intensivo, su ojo se recuperó completamente. Recomendamos el uso de guantes y gafas protectoras antes de manipular este tipo de plantas (AU)

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human's eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants (AU)

Keratouveitis and conjunctivitis caused by Euphorbia ingens: A case review.

Euphorbia ingens is a ubiquitous plant who has a milky sap. It can accidentally harm human´s eye by its caustic nature, causing conjunctivitis, keratitis, uveitis, anterior staphyloma and corneal scarring in untreated patients. We present the case of a patient whose eye came into contact with the milky sap. He suffered conjunctivitis, corneal epithelial defect and uveitis. After intensive treatment, his eye made a complete recovery. We recommend gloves and protecting glasses before handling these types of plants.

Infecciones oculares: un estudio de caracterización y perfil de resistencia antibiótica / Ocular infections: characterization and antibiotic resistance profile

Introducción: Las infecciones oculares son patologías frecuentes asociadas a secuelas graves como la ceguera y se convierten en un potencial problema en salud pública. Su perfil epidemiológico, en cuanto a su etiología, es conocido a nivel mundial, pero los perfiles locales son desconocidos, limitando los esfuerzos terapéuticos dirigidos para compartir dicho problema. Objetivo: Caracterizar los principales gérmenes encontrados en los cultivos tomados de la córnea y la secreción conjuntival de pacientes de un centro de referencia oftalmológica de Medellín. Método: Estudio descriptivo, observacional y retrospectivo a partir de los resultados de cultivos, realizando un análisis en función de variables categóricas emitiendo porcentajes y frecuencias. Resultados: Se obtuvieron 176 cultivos en total: el 61.4% fue de córnea y el 34.1% de conjuntiva; los gérmenes más frecuentemente aislados fueron Pseudomonas en un 25%, Staphylococcus aureus con un 20% y Fusarium con un 15%. Conclusión: Los gérmenes más frecuentes que encontramos en este estudio coinciden con los que habitualmente se reportan en la literatura

Background: Eye infections are frequent pathologies associated with serious sequelae such as blindness and they become a potential public health problem. Its epidemiological profile, in terms of its etiology, is known worldwide, but the local profiles are unknown, limiting targeted therapeutic efforts to share this problem. Objective: To characterize the main germs found in cultures taken from the cornea and conjunctival secretion of patients at an ophthalmological reference center in Medellín. Method: Descriptive, observational, and retrospective study based on the results of cultures, carrying out an analysis based on categorical variables, issuing percentages and frequencies. Results: A total of 176 cultures were obtained: 61.4% were from the cornea and 34.1% from the conjunctiva; the most frequently isolated germs were Pseudomonas in 25%, Staphylococcus aureus with 20% and Fusarium with 15%. Conclusion: The most frequent germs that we found in this study coincide with those that are usually reported in the literature

Toxicidad por marcador corneal en Femto-LASIK. Reporte de caso / Toxicity by corneal marker in Femto-LASIK. Case report

La violeta de genciana es un colorante orgánico sintético, descrito por primera vez por Charles Lauth en 1861. Tiene propiedades antibacterianas, antifúngicas, antihelmínticas, antitripanosómicas, antiantiogénicas y antitumorales. Tiene diversos mecanismos de acción, entre los que principalmente se encuentra bloquear la actividad de las nicotinamida adenina dinucleótido fosfato oxidasas, evitando la generación de radicales superoxidativos y la posterior inflamación. En los últimos años se ha utilizado en marcadores para procedimientos en diferentes especialidades médicas, incluidos los de oftalmología. La tinta de violeta de genciana se describe por el fabricante como no tóxica, sin embargo existe evidencia clínica y experimental que sugiere que puede ser tóxica para el endotelio corneal y puede llegar a generar queratitis lamelar difusa posterior a LASIK y Femto-LASIK. Se describe el caso de una paciente de 23 años de edad, que presentó diversas patologías en la córnea después del uso de marcador quirúrgico durante procedimiento refractivo Femto-LASIK.

Gentian violet is a synthetic and organic dye. First described by Charles Lauth in 1861. It has antibacterial, antifungal, anthelmintic, antitrypanosomal, antiangiogenic, and antitumoral properties. It has various mechanisms of action, among which is mainly blocking the activity of nicotinamide adenine dinucleotide phosphate oxidases, preventing the generation of superoxidative radicals and subsequent inflammation. In recent years, it has been used as markers for procedures in different medical specialties, including ophthalmology. Gentian violet ink is described by the manufacturer as non-toxic, however, there is clinical and experimental evidence suggesting that it may be toxic to the corneal endothelium and may cause diffuse lamellar keratitis after LASIK and Femto-LASIK. The case about a 23-year-old female patient who presented various pathologies in the cornea after the use of a surgical marker during the Femto-LASIK refractive procedure is described.

Revisión de la literatura sobre la evidencia disponible actualmente para el manejo de las queratitis infecciosas con PACK-CXL / Review of the literature on the currently available evidence for the management of infectious keratitis with PACK-CXL

Las queratitis infecciosas (QI) son una de las causas más comunes de ceguera a nivel mundial, especialmente en países en vías de desarrollo, y puede llegar a representar del 5,1 al 32,3% de todas las indicaciones de queratoplastia penetrante. Sin embargo, realizar una queratoplastia terapéutica «en caliente» está asociado con una mayor incidencia de recurrencia de la QI y rechazo del injerto. El tratamiento estándar incluye antimicrobianos (ATM) de amplio espectro y, una vez identificado el patógeno causante y el antibiograma, continuar con un tratamiento dirigido, según la sensibilidad del germen. La aparición de cepas multirresistentes a los ATM está aumentando progresivamente a un ritmo alarmante en los últimos tiempos. Asimismo, la diversidad de los microorganismos causantes (bacterias, hongos, parásitos, virus) dificulta en ocasiones la realización de un diagnóstico clínico correcto, retrasando el inicio de un tratamiento efectivo. Se estima que solo un 50% de los ojos tendrá un buen resultado visual si se retrasa la terapia. En definitiva, todos estos factores hacen que sea muy importante la identificación de alternativas al tratamiento ATM. Por las propiedades ATM del cromóforo fotoactivado (riboflavina) y la luz ultravioleta de longitud de onda 200-400nm, utilizada en múltiples aplicaciones médicas y no médicas para la desinfección, se ha propuesto el cromóforo fotoactivado para el cross-linking corneal en el tratamiento de las QI, como una herramienta adicional en el arsenal terapéutico de las QI. Debe diferenciarse del cross-linking empleado para el manejo del queratocono progresivo. El objetivo de esta revisión es actualizar la evidencia disponible sobre la eficacia y seguridad del cromóforo fotoactivado para el cross-linking en las QI (AU)

Infectious keratitis (IK) is one of the most common causes of monocular blindness worldwide, especially in developing countries, and may account for 5.1 to 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) and ultraviolet light of wavelength 200-400nm, used in multiple medical and non-medical applications for disinfection, photoactivated chromophore for corneal cross-linking (CXL) of IK, 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. The objective of this review is to update the available evidence on the efficacy and safety of photoactivated chromophore for corneal CXL in IKs (AU)

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.

Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile / Queratitis infecciosa por Staphylococcus epidermidis resistente a meticilina: perfil clínico y microbiológico

Introduction. Staphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. Ahigh percentage of resistance to methicillin is shown, whichgives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical andmicrobiological variables in patients with infectious keratitisdue to SE.Methods. Medical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE,between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions,treatment, evolution) and microbiological (susceptibility toantibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE)infection were compared.Results. MRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid.Rates of resistance to tetracyclines and ciprofloxacin were50% and 56% in the MRSE group, and 11% and 7% in theMSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not showstatistically significant differences between groups.Conclusions. MRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings (AU)

Introducción. Staphylococcus epidermidis (SE) es unacausa frecuente de queratitis bacteriana en ciertas áreas geográficas. Presenta un alto porcentaje de resistencia a meticilina, lo que confiere resistencia cruzada a beta-lactámicos y enalgunas ocasiones también resistencia a otros grupos de antibacterianos. Analizamos variables clínicas y microbiológicas enpacientes con queratitis infecciosa por SE.Métodos. Se analizaron retrospectivamente las historiasclínicas de 43 pacientes con sospecha de queratitis infecciosa yconfirmación microbiológica para SE, entre octubre de 2017 yoctubre de 2020. Se analizaron las características clínicas (factores de riesgo, tamaño de las lesiones, tratamiento, evolución)y microbiológicas (susceptibilidad a antibióticos) y se compararon grupos de pacientes con infección resistente (MRSE) ysensible a meticilina (MSSE).Resultados. El 37,2% de las queratitis fueron por MRSE.Todos los aislados fueron sensibles a vancomicina y linezolid.Las tasas de resistencia a tetraciclinas y ciprofloxacino fueron50% y 56% en el grupo de MRSE, y 11% y 7% en el grupode MSSE. Las características clínicas, incluido el tamaño de lalesión, la afectación del eje visual, la inflamación de la cámaraanterior, la presencia de factores de riesgo y el tiempo de seguimiento, no mostraron diferencias estadísticamente significativas entre los grupos.Conclusiones. MRSE es una causa frecuente de las queratitis infecciosas producidas por SE y presenta una alta tasade resistencia a múltiples fármacos. Clínicamente, no muestradiferencias clínicas con la queratitis por MSSE. Se necesitantrabajos adicionales para confirmar estos hallazgos. (AU)

Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery.

OBJECTIVE: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.º Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO. METHODS: An exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019. RESULTS: There is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis. CONCLUSIONS: Penetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals.

Evidencia en la prevención de la recurrencia de queratitis por herpes simple y herpes zóster tras cirugía ocular / Evidence in the prevention of the recurrence of herpes simplex and herpes zoster keratitis after eye surgery

Propósito: La queratitis herpética, ya sea por herpes simple (HSK) o por herpes zóster oftálmico (HZO) puede presentar recaídas tras la cirugía ocular. Se postula como necesaria una profilaxis para evitarla. El objetivo de este estudio es revisar la evidencia científica sobre los métodos preventivos empleados en el período perioperatorio en pacientes previamente afectados de HSK/HZO.MétodosSe ha realizado una búsqueda exhaustiva en las bases de datos PubMed y Web of Science para identificar artículos relevantes sobre profilaxis y riesgo de recurrencia de HSK/HZO en pacientes sometidos a cirugía ocular hasta el 31 de diciembre de 2019.ResultadosHay pruebas sólidas de que la profilaxis oral debe recomendarse tras una queratoplastia penetrante en pacientes que hayan sufrido previamente HSK/HZO. Para otros tipos de cirugías, la evidencia es menos convincente; sin embargo, debe considerarse un período latente de inactividad entre la enfermedad y la profilaxis oral.ConclusionesLa queratoplastia penetrante y lamelar, crosslinking corneal, cirugía de catarata y cirugía fotorrefractiva y fototerapéutica provocan una alteración del plexo nervioso sub-basal de la cornea. Debido al traumatismo quirúrgico, así como a la modulación de la respuesta inmunológica ocular causada por los esteroides aplicados en el postoperatorio, es posible inducir la reactivación de HSK/HZO, siendo en algunos casos común. Dentro del presente artículo discutimos la evidencia disponible para la profilaxis de HSK/HZO en cirugía ocular. Son necesarios estudios adicionales para definir el riesgo real de recurrencia de HSK/HZO después de cirugías oculares, particularmente en cirugía de catarata y para confirmar la eficacia de la profilaxis perioperatoria con antivíricos anti HSK/HZO (AU)

Objective: Herpetic keratitis, either due to herpes simplex keratitis (HSK) or herpes zoster ophthalmicus (HZO), can recur after eye surgery.° Prophylaxis is postulated as necessary to avoid it. The objective of this study was to review the scientific evidence on the preventive methods used in the perioperative period in patients previously affected by HSK/HZO.MethodsAn exhaustive search was carried out in the PubMed and Web of Science databases to identify relevant articles on prophylaxis and risk of recurrence of HSK/HZO in patients undergoing eye surgery up to 31 December 2019.ResultsThere is strong evidence that oral prophylaxis should be recommended after penetrating keratoplasty in patients who have previously had HSK/HZO. For other types of surgery, the evidence is less compelling. However, a latent period of inactivity should be considered between disease and oral prophylaxis.ConclusionsPenetrating and lamellar keratoplasty, corneal crosslinking, cataract surgery, and photorefractive and phototherapeutic surgery cause an alteration of the subbasal nerve plexus of the cornea. Due to surgical trauma, as well as the modulation of the ocular immune response caused by steroids applied in the postoperative period, it is possible to induce the reactivation of HSK/HZO, which is common in some cases. Within this article, we discuss the available evidence for HSK/HZO prophylaxis in eye surgery. Further studies are necessary to define the real risk of HSK/HZO recurrence after ocular surgeries, particularly in cataract surgery, and to confirm the efficacy of perioperative prophylaxis with anti-HSK/HZO antivirals (AU)

Queratitis por Mycobaterium abscessus: comunicación del primer caso en Paraguay / Keratitis due to Mycobaterium abscessus: first case report in Paraguay

Resumen Se presenta un caso clínico de queratitis por Mycobacterium abscessus en una mujer de 76 años, residente en la ciudad de Asunción, sin traumatismo ni cirugía ocular previa y con antecedente de una queratouveitis herpética. Por tratarse de una queratitis causada por un agente etiológico poco frecuente y por la importancia de un diagnóstico correcto y oportuno para la instauración del tratamiento adecuado, se comunica el primer caso de queratitis por micobacterias en Paraguay.

Abstract We present a clinical case of keratitis caused by M. abscessus in a 76-year-old female patient, resident in the city of Asunción, without trauma or previous ocular surgery and with a history of herpetic keratouveitis. Because it is a keratitis caused by a rare etiological agent and because of the importance of a correct and timely diagnosis for the establishment of appropriate treatment, the present case is reported, the first of Mycobacteria keratitis in Paraguay.

Características epidemiológicas, clínicas y oftalmológicas de pacientes con queratoconjuntivitis seca / Epidemiological, clinical and ophthalmologic characteristics of patients with keratoconjunctivitis Sicca

Introducción: La queratoconjuntivitis seca es una enfermedad de causa multifactorial, que afecta la producción de lágrimas y la superficie ocular, a la vez que ocasiona malestar, visión borrosa e inestabilidad de la película lagrimal. Métodos: Se realizó un estudio descriptivo y transversal de 50 pacientes con diagnóstico de queratoconjuntivitis seca, atendidos en el Centro Oftalmológico del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero hasta julio de 2020. Objetivo: Caracterizar a los pacientes con queratoconjuntivitis seca según variables epidemiológicas clínicas y oftalmológicas. Resultados: En la serie predominaron las féminas (66,0 %), los pacientes mayores de 60 años (40,0 %), la lectura excesiva como factor de riesgo (42,0 %), la irritación, la fatiga ocular y la visión borrosa como criterios diagnósticos, además de la disminución del tiempo de rotura de la película lagrimal en 68,0 % de la muestra, entre otros resultados. Conclusión: La queratoconjuntivitis seca, desde el punto de vista clínico y epidemiológico fue similar a lo descrito en la bibliografía especializada en cuanto a los grupos de edades, sexo y principales síntomas descritos.

Introduction: The keratoconjunctivitis sicca is a disease of multifactorial cause that affects the production of tears and the ocular surface, at the same time that causes discomfort, blurred vision and instability of the lacrimal thin layer. Methods: A descriptive and cross-sectional study of 50 patients with diagnosis of keratoconjunctivitis sicca, assisted in the Ophthalmolgic Center of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, was carried out from January to July, 2020. Objective: To characterize patients with keratoconjunctivitis sicca according to clinical, epidemiologic and ophthalmologic variables. Results: In the series there was a prevalence of the females (66.0 %), patients over 60 years (40.0 %), excessive reading as risk factor (42.0 %), irritation, ocular fatigue and blurred vision as diagnostic criteria, besides the decrease of the lacrimal thin layer break up time in 68.0 % of the sample, among other results. Conclusion: The keratoconjunctivitis sicca was similar to that described in the specialized literature review as for the age groups, sex and main described symptoms from the clinical and epidemiologic points of view.

Derretimiento corneal como complicación de queratitis ulcerativa periférica en un paciente con artritis reumatoide / Corneal melt as a complication of a peripheral ulcerative keratitis in a patient with rheumatoid arthritis

RESUMEN Las manifestaciones oculares de la artritis reumatoide son manifestaciones graves que requieren manejo agresivo. En el presente reporte presentamos un caso de queratitis asociada a derretimiento corneal desencadenado por suspensión abrupta de su medicación reumatológica y cirugía no ocular, que respondió de forma favorable al manejo con metil-prednisolona y ciclofosfamida.

ABSTRACT Ocular signs of rheumatoid arthritis are severe extra-articular manifestations, which usually require aggressive management. In this report, A case is presented here of patient with peripheral ulcerative keratitis associated with corneal melt syndrome triggered by abrupt suspension of antirheumatic medication and non-ocular surgery. They symptoms responded favourably to methylprednisolone and cyclophosphamide.

Imagenología diferencial por microscopia confocal in vivo entre la epiteliopatía por acanthamoeba y la queratitis por herpes simple / In vivo confocal microscopy imaging for the differential diagnosis of Acanthamoeba epitheliopathy and herpes simplex keratitis

La queratitis por Acanthamoeba es una infección corneal de baja incidencia, condicionada por varios factores, pero con manifestación clínica variada y sintomatología típica. En su fase epitelial debe ser diferenciada de otras queratitis, específicamente de la queratitis por herpes simple, por la similitud entre ambas en cuanto a las características de la lesión corneal. La microscopia confocal in vivo constituye una alternativa diagnóstica. Es una biopsia fotográfica en cuyas imágenes podemos describir los quistes y trofozoítos de Acanthamoeba desde etapas iniciales, que nos ayudan a diferenciarla de otros tipos de queratitis e iniciar el tratamiento precoz. Se realizó una búsqueda de artículos publicados, con el objetivo de mostrar las imágenes por microscopia confocal de la fase epitelial de la infección corneal por Acanthamoeba y herpes simple. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Acanthamoeba keratitis is a low-incidence corneal infection caused by several factors and characterized by a variety of clinical manifestations and typical symptoms. In its epithelial phase, it should be differentiated from other keratitis, particularly from herpes simplex keratitis, due to the similar characteristics of the corneal lesion. In vivo confocal microscopy is a diagnostic alternative consisting in a photographic biopsy showing images of Acanthamoeba cysts and trophozoites since their initial stages, thus allowing differentiation from other types of keratitis and the initiation of early treatment. A search was conducted of published papers with the purpose of showing confocal microscopy images of the epithelial phase of Acanthamoeba and herpes simplex corneal infection. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Early Penetrating Keratoplasty after interface fungal keratitis in Descemet Membrane Endothelial Keratoplasty. / Queratoplastia penetrante temprana después de queratitis fúngica de la interface en la queratoplastia endotelial de la membrana de Descemet.

In this case-report we describe the first reported case of early-onset fungal interface keratitis (IK) after Descemet Membrane Endothelial Keratoplasty (DMEK) successfully treated with penetrating keratoplasty (PK) during the active stage of infection. A patient with graft failure after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) was operated on with DMEK. Donor rim culture and broth were positive for Candida albicans. Several interface infiltrates were confirmed and localized using anterior segment optical coherence tomography. Three days after diagnosis, observing clear signs of intraocular infection, the graft was removed with simultaneous washed-up of anterior chamber with fluconazole 1% followed by a PK and intrastromal corneal injections of fluconazole. A best-corrected visual acuity of 20/20 was achieved. This case highlights the importance of analysing every donor rim and broth, despite the patient doesn't show any symptoms or signs during the post-operative period. PK is a viable treatment option in early-onset interface keratitis.