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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.

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), and 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.

Resumen Objetivo Describir el resultado visual de los pacientes intervenidos de queratoprotesis de Boston tipo 1 (QB1), asi como las complicaciones postoperatorias graves que afecten a la vision en estos pacientes. Metodos Se realizo un analisis de los expedientes clinicos de todos los pacientes que recibieron QB1 en nuestra institucion 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 anos (rango 2-90). Los diagnosticos mas frecuentes fueron la queratopatia ampollosa, enfermedades autoinmunes como el sindrome de Stevens-Johnson (SSJ)/sindrome de Lyell (SL) y queratopatia aniridica. El promedio de queratoplastias (QP) previas fue de 2,36 (rango 0-8) y el de cirugias 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 cirugia fue de 2,05 (rango 1,10-2,52) y la MAVC conseguida despues de la cirugia fue de 1,16 (rango 0,08-2,70). La complicacion mas frecuente fue la formacion de membrana retroprotesica (MRP), la cual aparecio en 22 (53,65%) ojos. De estas, 6 (27,27%) fueron posteriores a otra cirugia. Requirieron tratamiento 14 (63,63%) MRP, un promedio de 1,71 (rango 1-4) aplicaciones de laser YAG y en tres pacientes membranectomia quirurgica. En 11 (26,82%) ojos se presentaron problemas de adherencia coriorretinianos, seis (14,63%) de los cuales sucedieron despues de otra cirugia 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. Conclusiones La funcion visual mejoro en la mayoria de pacientes. Aquellos con multiples cirugias oculares previas y alteraciones de la inmunidad sistemica como SSJ, SL o diabetes mellitus (DM) presentan un mayor riesgo de presentar complicaciones graves que afecten a la vision, como MRP, desprendimientos coriorretinianos e infecciones. A pesar de todo, consideramos que es una alternativa efectiva en pacientes con enfermedad ocular multiple e inminente riesgo de rechazo de una nueva QP.

Case report: An 80-year-old woman diagnosed with a recurrent squamous conjunctival carcinoma treated with surgical excision of the lesion, zonal reconstruction and topical interferon alpha 2. 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. © 2010 Sociedad Espa ˜

Resumen Caso clinico Mujer de 80 anos de edad diagnosticada de carcinoma escamoso conjuntival recidivante tratado con escision quirurgica de la lesion, reconstruccion zonal e interferon alfa 2-β topico. Discusion La neoplasia escamosa de la conjuntiva y cornea es el tumor mas frecuente de la superficie ocular. La cirugia mediante reseccion de la lesion es el metodo tradicional de tratamiento de estos tumores, pero presenta un elevado indice de recurrencias. La inmunoterapia es una alternativa actual para estos tumores. Los interferones son glicoproteinas que actuan activando una cascada de eventos intracelulares que confieren una actividad antivirales y antitumoral. Su actividad frente a las neoplasias epiteliales de la superficie ocular se ha demostrado en los ultimos anos.

Resumen Caso clinico Varon de 68 anos con vasculopatia polipoidea coroidea idiopatica que requirio 7 inyecciones intravitreas de bevacizumab en el cuadrante nasal-superior. Posteriormente desarrollo una insuficiencia limbar localizada que requirio un autoinjerto limbar homolateral. A los dos meses de la cirugia, existia una discreta mejoria de la agudeza visual, observandose una cornea mas transparente, un epitelio integro y una notable mejoria en la alteracion de la superficie ocular. Discusion Los traumatismos quirurgicos repetidos sobre la region limbar o zonas proximas a ella pueden ocasionar una alteracion de las celulas madre limbares originando una epiteliopatia corneal por insuficiencia limbar yatrogenica, entre cuyas causas deben considerarse las inyecciones intravitreas frecuentes.

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.

Different femtosecond laser platforms are nowadays available. Main differences as the particular approaches in anterior segment imaging techniques to focus the laser pulses precisely, interface designs to efficiently and safely dock the patient´s eye and software options in each platform will be presented and discussed.

To describe the visual outcome of patients who underwent Boston type 1 keratoprosthesis (KPro1) implantation, and describe serious sight-threatening post-operative complications.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.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.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.

Caso clínico: Varón de 68 años con vasculopatía polipoidea coroidea idiopática que requirió 7 inyecciones intravítreas de bevacizumab en el cuadrante nasal-superior. Posteriormente desarrolló 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 la alteración de la superficie ocular. Discusión: Los traumatismos quirúrgicos repetidos sobre la región limbar o zonas próximas a ella pueden ocasionar una alteración de las células madre limbares originando una epiteliopatía corneal por insuficiencia limbar yatrogénica, entre cuyas causas deben considerarse las inyecciones intravítreas frecuentes. 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.

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.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.

Purpose To analyse the refractive and biomechanical changes in the cornea after implantation of intrastromal ring segments. Methods The study included 43 eyes of 36 patients (mean age 38 years); 7 eyes had received Intacs® and 36 KeraRings®. Visual acuity, spherical equivalent, K readings, corneal hysteresis (CH) and corneal resistance factor (CRF) were measured pre-op, at 6 and at 12 months post-op. CH and CRF were derived from the Ocular Response Analyser (ORA). Results UCVA improved from 1.10 logMAR to 0.65 at 6 months and 0.62 at 12 months post-op. BCVA improved from 0.32 logMAR to 0.25 at 6 months and 0.22 at 12 months post-op. Spherical equivalent improved from -5.28 to -1.30 at 6 months and -1.85 at 12 months post-op. Sim K improved from 5.81 to 3.64 at 6 months and 4.10 at 12 months post-op. Mean K improved from 48.9 to 46.3 at 6 months and 46.7 at 12 months post-op. All changes between pre-op and 6 months post-op were significant, but between 6 months and 12 months they were not. Pre-op CRF (mean 6.37) and CH (mean 7.34) did not change significantly up to 12 months post-op. Conclusion Intrastromal ring segments for keratoconus reduced the spherical equivalent refraction and improved the UCVA and BCVA at 6 months post-op and remained stable up to 12 months. ORA's biomechanical factors CH and CRF did not changed up to 12 months post intrastromal ring segment implantation.

Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered.

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.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.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.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.

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 conjuncitval 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.