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Purpose To report the effectiveness of the surgical procedure of the tarsoconjunctival flap (FTC) in patients with severe ocular surface impairment refractory to previous conventional treatments. Methods A retrospective, noncomparative, consecutive case series. Results Pillar tarsoconjunctival flap (PTCF) was performed in eight eyes of eight patients. Three patients had neurotrophic corneal ulcer (NCU), three had exposure keratopathy and two had corneal melting. Seven of them had satisfactory postoperative results, showing total corneal re-epithelialization that lasted throughout the postoperative follow-up (mean 10.33 ± 2.65 months [SD], range 6 to 12 months). Mean time for the re-epithelization was 11.28 ± 8.97 days [SD] (range 4 to 30 days). Conclusion This study suggest PTCF is a valid alternative to tarsorrhaphy in cases of persistent epithelial defect (PED) or NCU resistant to conventional treatments. Notwithstanding, prospective comparative trials comparing PTFC with conventional and/or novel therapies in PED or NCU are needed to corroborate these findings.

PURPOSE To describe the effectiveness and safety of nicergoline in patients with epithelial corneal defect or corneal ulcer due to neurotrophic keratitis (NK). METHODS A prospective case series review was performed in 14 patients with NK who started treatment with nicergoline as an off-label prescription from January to November 2020. Patients with a epithelial defect or corneal ulcer due to NK were treated with oral nicergoline. RESULTS/SERIAL CASES Complete corneal healing was observed in 10 (71.4%) of the 14 patients after 25.6 ± 26.60 days (range 7-90) with nicergoline. In three (21.5%) patients wound healing was not achieved, and one patient (7.1%) was lost to follow-up. The mean time between diagnosis and the starting of nicergoline was 10.92 ± 8.85 days (0-28). No adverse effects of nicergoline were observed. CONCLUSION Nicergoline as an adjunctive treatment for NK showed a potential use in the healing of epithelial defect in real-life clinical practice.

To analyze astigmatism axis changes after tropicamide and phenylephrine combined instillation.One hundred and thirty-one eyes from 66 patients enrolled this cross-sectional study. An extensive ocular examination was carried out prior to tropicamide and phenylephrine instillation. Power and axis value from flat, steep, and mean keratometry were calculated using an Auto Kerato-Refractometer (AKR). Later, topography and tomography maps were evaluated with Pentacam HR® (Oculus, Wetzlar, Germany). Subsequently, a single drop of tropicamide 1% and phenylephrine hydrochloride 10% were instilled twice, with a five-minute gap between each instillation. After 30 minutes, the AKR and Pentacam HR® tests were repeated.Incyclotorsion was found in 59 eyes (45.1%) and mean absolute incyclotorsion change was 3.91 ± 3.62 degrees (0.10 to 14.20). Excyclotorsion was found in 72 eyes (54.9%) and mean excyclotorsion change was 4.99 ± 5.94 degrees (0.20 to 36.20). We observed that 74.6% and 68.1% of eyes experienced incyclotorsion and excyclotorsion within 0 to 5 degrees, respectively. Fewer patients experienced incyclotorsion and excyclotorsion changes within 5 to 10 degrees, precisely 11.8% and 19.4%, respectively. Eyes that experienced over 10 degrees of incyclotorsion and excyclotorsion were 13.6% and 12.5%, respectively.Astigmatism axis could change after combined tropicamide and phenylephrine instillation. Reference axis marking in astigmatism correction surgery should be performed under the same circumstances as the astigmatism axis has been measured.

Primary biliary cirrhosis is a rare progressive autoimmune liver disease that causes chronic cholestasis. Of patients with primary biliary cirrhosis, 75% develop secondary Sjogren syndrome and could develop vitamin A deficiency. Here, we report the case of a patient with primary biliary cirrhosis who developed a secondary Sjogren syndrome and vitamin A deficiency, which led to severe and unusual eye involvement with multiple and recurrent spontaneous corneal perforations. Corneal perforations in patients with primary biliary cirrhosis and secondary Sjogren syndrome are rare but devastating complications, in contrast to other eye clinical manifestations of the disease.

Purpose: To evaluate the accuracy of 12 intraocular lens (IOL) power formulas; Barrett Universal II, Emmetropia Verifying Optical (EVO), Haigis, Hill-Radial Basis Function (RBF), Hoffer Q, Holladay I, Kane, Ladas Super Formula, Olsen Lenstar, Panacea, Pearl-DGS, Sanders-Retzlaff-Kraff/theoretical (SRK/T). In addition, an analysis of the efficacy as a function of the axial length was performed. Methods: About 171 from 93 patients: 68 male eyes and 103 female eyes. Twelve IOL power formula calculations were studied with one IOL platform (trifocal hydrophilic IOL, FineVision Micro F), one biometer (Lenstar LS 900), one topographer (CSO Sirius Topographer), one surgeon, and one optometrist. Optimization were determined to be zeroed mean refractive prediction error. Mean error (ME), mean absolute error (MAE), median absolute error (MedAE) and refractive accuracy within ±1.00 D was calculated. Axial length was split in short and medium eyes. Results: One hundred and seventy eyes were included. Formulas were ranked by percentage within ±0.50 diopters and MAE (D). Among all eyes, Olsen 86.55% (0.273 D) and Barrett Universal II 86.55% (0.285D). For short eyes (Conclusion: Olsen and Barrett formula obtained excellent accuracy for overall eyes. Kane and Olsen formula obtained the best results in short eyes. For medium axial length Barrett formula achieved the best accuracy results.

Purpose To assess agreement between corneal aberration measurements made through swept-source optical coherence tomography using a new anterior segment imaging device (Anterion) and a Scheimpflug imaging device (Pentacam HR) in healthy subjects. Methods Cross-sectional study. In 50 eyes of 50 healthy subjects, 14 aberration parameters (7 across the anterior corneal surface and 7 across the total surface) were measured in 4 mm and 6 mm optic zones using each device: oblique trefoil (Z3_-3), vertical coma (Z3_-1), horizontal coma (Z3_1), horizontal trefoil (Z3_3), spherical aberration (Z4_0), root mean square (RMS) lower order aberrations (LOA) and RMS higher order aberrations (HOA). Data for the two devices were compared through intraclass correlation coefficients (ICC), paired t tests, limits of agreement (LoA) and Bland Altman plots. Results Vertical coma was the only corneal aberration parameter that consistently showed excellent agreement (ICC > 0.8, mean difference −0.019, LoA −0.165 to 0.126). Good agreement (ICC = 0.75) between the devices was observed for RMS HOA, but this was slightly worse in the 6 mm optical zone (ICC = 0.667 for anterior RMS HOA). No over- or underestimation trend by one or other device was noted. Agreement was poor to moderate for the rest of the corneal parameters (ICC 0.2 to 0.7). Conclusion Despite good agreement overall for vertical coma and RMS HOA values, agreement for the remaining corneal aberration measurements was poor to moderate. As mean differences in our sample were overall small, in normal eyes these devices could be clinically judged as interchangeable.

To determine corneal topographic, anatomic, and biomechanical properties in patients newly diagnosed with severe obstructive sleep apnea-hypopnea syndrome (OSAHS).This is a cross-sectional study including 25 patients recently diagnosed with severe OSAHS (apnea-hypopnea index above 30) and a paired control group of 25 healthy subjects. All patients underwent a complete eye examination with an elevation topography Pentacam Scheimpflug study and a study with Reichert Ocular Response Analyzer, collecting several topographic, anatomic, and biomechanical variables.Fifty eyes of 25 patients (23 of them were men) diagnosed with OSAHS by somnography and the same number of healthy subjects (23 of them were men) were included, with an average age of 64 ± 11 years (range 45-78 years) for cases and an average age of 64 ± 11 years (range 45-81 years) for the controls. No differences were found in keratometry, cylinder, refractive indexes, Bad-D, or pachymetry. The mean corneal volume for cases was 58.64 ± 3.05 mm and for the controls 60.48 ± 3.33 mm (P = 0.005). The mean minimum radius for cases was 7.49 ± 0.31 and for the controls 7.36 ± 0.30 (P = 0.035). The mean elevation in apex for cases was 8.46 ± 5.18 and for the controls 2.38 ± 2.36 (P ≤ 0.001). Two eyes with a topographic diagnosis of keratoconus (KC) and another 6 with subclinical KC were detected using the Pentacam in the OSAHS group.Many of the corneal topographic and biomechanical variables in patients with severe OSAHS present different values from the general population with a trend toward KC values, such as keratoconus index or paired keratoconus index. Compared with the control group, significant differences were found in corneal volume, corneal elevation, and minimum radius.

This paper will evaluate chord mu and alpha length in patients with Fuchs endothelial corneal dystrophy (FECD) and its changes following Descemet membrane endothelial keratoplasty (DMEK). Patients with FECD that underwent DMEK surgery were included in this retrospective study. Scheimpflug Tomography was carried out in order to calculate chord mu and chord alpha lengths prior to surgery and at 3 and 12 months postoperative. This study included 27 eyes from 27 patients. Significant changes in chord mu were observed within the first three months (from 0.47 ± 0.32 to 0.29 ± 0.21 mm, p &lt, 0.01) and remained stable 12 months postoperative (0.30 ± 0.21 mm, p &gt, 0.05). However, chord alpha remained stable throughout the 12 months post surgery (from 0.53 ± 0.19 to 0.49 ± 0.14 mm, p &gt, 0.05). In addition to the pupillary center distance from the corneal apex (from 0.35 ± 0.25 to 0.34 ± 0.20 mm, p &gt, 0.05) also remain stable. In FECD patients undergoing DMEK surgery, chord mu length decreased, and chord alpha length remained stable after 12 months of follow-up.

This study examines agreement between the devices Anterion® and Pentacam HR® used for corneal and pupil measurements in healthy eyes. The parameters compared between the two devices were: anterior Km (D), anterior K2 (D), anterior K1 (D), anterior K1 axis (°), anterior astigmatism (D), anterior K max (D), posterior Km (D), posterior K2 (D), posterior K1 (D), posterior K1 axis (°), posterior astigmatism (D), CCT (µm), thinnest point thickness (µm), thinnest point X-coordinate (mm), thinnest point Y-coordinate (mm), pupil diameter (mm), pupil center-corneal vertex distance (mm) (angle kappa), pupil centroid angle (°), pupil centroid X-coordinate (mm), and pupil centroid Y-coordinate (mm). The Student’s t test for independent samples identified significant differences (p < 0.005) between devices for the measurements anterior and posterior flat K axis, posterior flat K, steep K, and mean K. For these last three measurements, although significant, none of the differences were clinically relevant. Corneal power and thickness measurements except Kf axis showed excellent agreement between Anterion and Pentacam. In a clinical setting we would not recommend the interchangeable use of Pentacam and Anterion for measurement of pupil parameters.

This systematic review reported the outcomes of laser corneal refractive surgery in pregnant or breastfeeding patients. This study was performed by searching in PubMed, Web of Science, and Scopus databases, on June 15, 2020. Included were 128 eyes from a total of 64 patients, with the mean maximum follow-up was 39.2 ± 36.14 months. Time from surgery to complication ranged from 1 to 67 months, with a mean value of 23.42 ± 22.23 months. Photorefractive keratectomy and laser in situ keratomileusis surgery seem to be stable procedures that are not modified during pregnancy and safe to complete during breastfeeding. Nevertheless, the lack of weight prospective research avoids having a greater certainty on this matter, and because of transitory nature of pregnancy and breastfeeding, it could still be contemplated that surgery risk outweigh the benefits. Additional investigation will be necessary to clarify these issues.

PURPOSE To describe paediatric keratoconus (KC) patients by tomographic and aberrometric characteristics at first diagnosis, in a multicentre study. METHODS We included 278 eyes from 139 paediatric patients, with a first tomographic diagnosis (Pentacam® ) of KC prior to 18 years old. KC classification was based on the KC Index (≥ 1.07) and Topographic Keratoconus Classification (TKC ≥ 1). Patients were divided based on age ranges (14 and under and over 14 years) and gender. Statistical analysis was performed with SPSS statistics 25.0. ANOVA factor was carried out comparing to compare groups. RESULTS 278 eyes were screened, and 230 eyes were diagnosed with paediatric KC. Mean age was 15.48 ± 2.33 (6 to 18) years. We found differences in terms of TKC (2.08 ± 0.89 and 2.38 ± 0.82, p

To compare corneal densitometry in a consecutive series of 52 endothelial keratoplasties (DMEK/DSAEK) using a Scheimpflug-based device after six months of follow-up. Corneal densitometry (CD) values of 102 eyes were divided into three main groups: 33 DMEKs, 19 DSAEKs, and 50 healthy eyes without previous ocular surgery. The CD values were then analyzed and compared between the groups. We measured three main layers in depth and four different concentric zones at 1, 3, and 6 months postoperatively. In the DMEK group, total CD significantly decreased from 38.02 ± 10.21 grayscale units (GSU) to 31.13 ± 9.25 GSU (P

PURPOSE To describe a new algorithm to measure corneal densitometry based on images obtained by swept source anterior segment ocular coherence tomography (SS-AS-OCT) and establish standard densitometry values in a group of normal eyes. METHODS A total of 111 healthy participants (195 eyes) were enrolled in this study. Using a MATLAB designed algorithm, the cornea was segmented into three layers: anterior, posterior and mid-stroma, and it was divided into two concentric areas, 0-2 and 2-4 mm, resulting in nine areas for the analysis. The mean corneal densitometry values were calculated and expressed as grayscale units (GSU). RESULTS The mean age was 57 years (range 22-87), with 100 (51.3%) right eyes and 95 (48.7%) left eyes. The total corneal densitometry was 86.9 ± 12.1 GSU. The mid-stroma layer had the highest densitometry values, 87.4 ± 12.1 GSU, and the anterior layer had the lowest values, 81.9 ± 14.2 GSU. Densitometry differences between the anterior layer and the mid-stroma layer (P

To assess the height, area, and density of tear meniscus throughout 10 min after instillation of sodium hyaluronate (SH) of equal molecular weight at two different concentrations.Thirty-four eyes from 17 patients were enrolled in this longitudinal, nonrandomized, interventional and contralateral eye study. Tear meniscus height (TMH), corneal meniscus junction (CMJ), lower-lid meniscus junction (LLMJ), and tear meniscus area (TMA) images were obtained with the anterior segment module of the deep range imaging ocular coherence tomography ([DRI-OCT] Triton Swept-Source). Tear meniscus density (TMD) was calculated using the image processing and analysis software by Java (ImageJ program). Sodium hyaluronate artificial tears at 0.1% and 0.2% concentrations were instilled into all right and left eyes, respectively.Patients' mean age was 61.05±11.43 years. Tear meniscus height, CMJ, LLMJ, and TMA measured at 1-, 5-, 7- and 10-min postinstillation of 0.1% SH proved significant differences among them (P0.05). Sodium hyaluronate 0.2% instillation obtained similar findings, although no significant differences were found between 1- and 3-min postinstillation measurements (P0.05). Fewer differences were found in TMD 0.2% SH group due to a lower baseline densitometry compared to the 0.1% group.0.2% sodium hyaluronate achieved better TMH and TMA in 1 and 3 min after instillation than 0.1% concentration. However, there were no statistically significant differences between 0.1% and 0.2% sodium hyaluronate throughout a ten-minute longitudinal profile measurement using DRI-OCT.

Summary Introduction To determine outcomes of conjunctival autograft attached with fibrin glue (FG) for primary pterygium , and compare these outcomes in expert versus closely supervised trainee ophthalmologists. Methods This was a retrospective, comparative, non-randomized, interventional study. Patients were recruited among those with primary nasal pterygium undergoing FG conjunctival autograft. Surgery was performed by expert (136 eyes) or closely supervised trainee (128 eyes) ophthalmologists. Mean follow-up was 7.82 ± 8.23 months. Main outcome measures were recurrence rate, reoperation rate and complications. Results The study sample comprised 264 eyes of 225 patients. Participants were of mean age 47.09 ± 12.89 years; 46.7% were male, 28.4% Caucasian and 70.5% Hispanic. Recurrence was recorded in 6.4%: 5.9% in the expert group and 7% in the trainee group (P = 0.704) and reoperation in 1.9%: 0.7% and 3.1% (P = 0.202), respectively. Both groups showed similar rates of complications such as transient graft edema, graft dehiscence, hematoma or ocular hypertension . Reoperation was slightly more frequent in patients younger than 40 years (P = 0.064). Conclusions Good outcomes were observed for FG conjunctival autografting in primary pterygium surgery, with no differences recorded between supervised trainee and expert surgeons. Our findings suggest the need to supervise pterygium surgeries during training.

To evaluate the clinical outcome of 500 consecutive cases up to 2 years after Descemet membrane endothelial keratoplasty (DMEK) and to assess which parameters may have influenced the clinical outcome.From a group of 500 eyes (393 patients), which underwent DMEK for Fuchs endothelial corneal dystrophy (FECD), bullous keratopathy, failed corneal transplants and other indications, clinical outcomes [best-corrected visual acuity (BCVA), central endothelial cell density (ECD), and central corneal thickness] were evaluated before, and at 6, 12, and 24 months after DMEK and postoperative complications were documented.At 12 months postoperatively, 81% of eyes reached a BCVA of ≥20/25 (≥0.8), 49% ≥20/20 (≥1.0), and 15% ≥20/18 (≥1.2) (n = 396) and remained stable up to 24 months (P = 0.828). Compared with preoperative ECD, mean postoperative ECD decreased by 37 (±18)%, 40 (±18)%, and 45 (±18)% at 6, 12, and 24 months, respectively (P0.05 for all time points). Surgery indication and graft attachment status were related to postoperative BCVA and ECD results. Eyes with FECD and attached grafts showed better BCVA outcomes and higher ECD (P0.05). Central corneal thickness decreased by 20 (±11)% to 525 (±46) μm from preoperative to 6 months postoperatively and remained stable thereafter (P0.05). Within the study period, retransplantation was required in 32 eyes (6.4%). Principal longer-term complications were secondary graft failure (1.4%) and allograft rejection (1.4%).Clinical outcomes remain excellent up to 2 years after DMEK, in particular for eyes operated on for FECD and with completely attached grafts.

Purpose: To assess changes in aqueous humor (AH) levels of cytokines following dexamethasone intravitreal implant (DEX) injection for diabetic macular edema (DME).Methods: Sixteen DME and cataract cases series study. Anterior chamber AH sampling was performed at baseline at DEX injection time (T1), cataract surgery 8 weeks afterward (T2), and whenever DME relapsed (T3) in order to assess changes in IL-1β, IL-3, IL-6, IL-8, IL-10, MCP-1, IP-10, TNF-α, and VEGF levels.Results: IP-10 and MCP-1 levels significantly decreased at T2 (p = .034 and p = .044, respectively) compared to baseline (T1). Relapsed DME cases (T3) showed significantly higher levels of IL-6 (p = .028), IL-8 (p = .005), IP-10 (p = .013) and MCP-1 (p = .005) compared to T2.Conclusion: IP-10 and MCP-1 AH levels seem to be related to DEX intraocular action, decreasing after injection and increasing when DME relapses. In addition, IL-6 and IL-8 may play a role in DME late evolution and clinical relapse beyond DEX effect.

Summary Purpose To observe trends in surgical techniques for corneal transplantation and main indications in our hospital over the past five years. Methods Retrospective descriptive study, including all keratoplasties performed at the Hospital Clinic of Barcelona, Spain, between January 2014 and December 2018. Results In total, 332 keratoplasties were performed. In total, 127 (38.25%) were penetrating keratoplasties (PK), and 205 (61.75%) were lamellar keratoplasties (LK). In 2014, a total of 48 keratoplasties were carried-out, whereas in 2018, the total was 93, which represents a 93.75% increase in corneal transplantation surgeries. Eye bank-delivered precut tissue for DMEK was introduced in 2016, and 3 cases (6.25%), were carried out that year. In 2018, DMEK became the leading technique with 56 cases (60.22%). Fuchs’ dystrophy was the leading indication for corneal transplant (37.63%) in 2018. Conclusion Introduction of DMEK in a single center can be implemented in a relatively short period of time, becoming the most popular surgical procedure in corneal transplantation. A possible factor encouraging this change is the availability of eye bank-delivered precut tissue, and standardization of donor preparation and host surgical steps, optimizing surgical time in the operating room. This trend should lead to better visual outcomes, faster recovery times, and eventually to a higher surgical volume per year.

PURPOSE To study the influence of different intraoperative air tamponade times on graft adherence after Descemet membrane endothelial keratoplasty (DMEK). METHODS In this interventional case series, we evaluated 117 eyes with Fuchs endothelial corneal dystrophy (FECD) that underwent DMEK using intraoperative air tamponade times of 60 minutes (group I; n = 39), 45 minutes (group II; n = 39), or 30 minutes (group III; n = 39). At 1 and 6 months postoperatively, graft adherence status, endothelial cell density, central pachymetry, and postoperative complications were recorded. RESULTS At 1 month, 19 of the 117 eyes (16.2%) showed a clinically significant detachment (>1/3 of the graft surface area and affecting visual axis): 6 eyes in group I (15.4%), 5 eyes in group II (12.8%), and 8 eyes in group III (20.5%) (P = 0.82). A minor detachment (

Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 &plusmn, 139.33 and 1059.00 &plusmn, 421.84 cells/mm2, respectively), pachymetry (621.20 &plusmn, 33.74 and 529.70 &plusmn, 30.00 &micro, m, respectively), and follow-up (45.50 &plusmn, 24.76 and 15.50 &plusmn, 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study.

A 30-year-old woman diagnosed of Cogan's syndrome (CS) with a chronic interstitial keratitis suffered from fungal keratitis and endophthalmitis after penetrating keratoplasty (PK). Microbiological cultures revealed a Candida albicans infection of the corneal graft. The corneoscleral rim was found out to be contaminated by this fungal species. Antifungal treatment, lensectomy and PK were performed. Fungal-related postoperative complications might be considered in a torpid postoperative course after PK specifically in immunosuppressed patients such CS. Routine corneoscleral rim culture may help to identify those patients who could benefit of prophylactic treatment.

Descemet membrane endothelial keratoplasty (DMEK) has become an increasingly popular first line treatment for patients with corneal endothelial disorders and corneal decompensation. The standard surgical technique, and alternative unfolding techniques and their rationales will be discussed.

Case report A 24-year-old woman who complained of maculo-papulo rash, genital and buccal aphthous ulcers, abdominal pain, minor dyspnea and visual loss in both eyes was presented for treatment. Funduscopy revealed a bilateral occlusive vasculitis including the central vessels. Treatment was initiated with a methylprednisolone bolus (1 g/24 h) and infliximab 5 mg/kg/day (0–2–6 weeks and every 8th week). The treatment prescribed induced a fast remission. Visual acuity improved. The patient did not suffer any other relapse after one year of follow-up. Discussion An initial treatment with Infliximab should be considered in Behcet disease for serious outbreaks, such as macular occlusive vasculitis with ischemia.

Resumen Caso clinico Mujer de 24 anos con rash maculopapular, aftas orales y genitales, dolor abdominal, disnea leve y disminucion de la agudeza visual en ambos ojos. La funduscopia revelo una vasculitis oclusiva bilateral que incluia los vasos centrales. Se inicio tratamiento con bolos de metilprednisolona (1 g/24 h) e infliximab 5 mg/kg/dia (0-2-6 semanas y cada 8 semanas). El tratamiento indujo una rapida remision. La agudeza visual mejoro. Tras un ano de seguimiento no ha presentado ningun nuevo brote. Discusion Un tratamiento de inicio con infliximab debe considerarse en brotes graves de enfermedad de Behcet como una vasculitis oclusiva bilateral con isquemia.

To report the 6-month clinical outcomes of a large cohort of Descemet membrane endothelial keratoplasty (DMEK) eyes operated by 55 starting or experienced surgeons.This is a retrospective, multicenter, interventional, cohort study with a total of 2485 eyes. Best-corrected visual acuity (BCVA), endothelial cell density (ECD) decrease, and intra- and post-operative complications were evaluated. Three groups based on case order were compared: group I (cases 1-24), group II (cases 25-99), and group III (cases ≥100). Forty-nine percent of the surgeons were in their learning curve (25 cases), representing 10.4% of the surgeries.Six months after DMEK, BCVA improved in 90.5% of eyes, remained unchanged in 4.6%, and deteriorated in 4.9% (n = 1936); 75.4% of eyes reached a BCVA of ≥20/40 (≥0.5), 45.4% ≥20/25 (≥0.8), and 25.8% ≥20/20 (≥1.0) (n = 1959) and ECD decreased by 40% (±19) (n = 1272, P0.05). BCVA and ECD outcomes did not differ between groups I and III (P0.05). Intraoperative complications were reported for 9.4% of eyes, whereas graft detachment was the main postoperative complication (27.4%), with lower intra- and post-operative complication rates in group III than group I (P0.05). Rebubbling was performed in 20.1% of eyes; 13.8% required secondary keratoplasty within 6 months.DMEK is applicable for surgeons in various settings with good clinical outcomes. After an arbitrary learning curve (25 cases), virtually all transplant-related complications declined with experience. Notably, surgeons with a higher annual caseload may pass faster through their learning curve than surgeons performing their first surgeries over an extended period.

Las drusas del nervio optico (DNO) son estructuras redondeadas de naturaleza calcica que se desarrollan en el nervio optico, evolucionando de forma dinamica en la edad adulta y originando graves alteraciones campimetricas. Suelen aparecer en discos opticos pequenos probablemente por el bloqueo del transporte axonal que origina su acumulo. Suelen ser bilaterales, asimetricas, de patogenesis desconocida e incidencia de 3-4/1.000 habitantes, con predileccion por el sexo femenino1--4.