We report herein a case of a child with nephrotic syndrome (NS) who presented with acute convergent strabismus, double vision, and papilledema one week after a history of badly treated sinusitis. The imaging study revealed an extensive thrombosis of the intracranial sinuses that was treated with intravenous heparin and oral corticosteroids. Four months later, the case evolved with spontaneous resolution of ocular deviation and diplopia.

Purpose: To determine the activity of metformin in an in vitro model of posterior capsule opacification (PCO). Study Design: Experimental laboratory research. Methods: The HLE-B3 lens epithelial cell line was treated with PCO induction media (PCOM) supplemented with transforming growth factor-beta (TGF-β) and fibro-blast growth factor (FGF). Different metformin concentrations (0-100 mM) were used. The following cellular parameters were assessed: (1) survival, using a viability assay; (2) morphology, via microscopy and image analysis; (3) migration, using the wound assay; (4) and expression of epithelial (Pax6, E-cadherin) and mesenchymal (α-smooth muscle actin or α-SMA, fibronectin) markers via Western blot. Expression of the uptake receptor SLC22A1 was evaluated in HLE-B3 and in human donor eyes with Western blot and immunohistochemistry, respectively. Statistical analysis of variance (ANOVA) with Tukey post-hoc test was done for analysis of cytotoxicity, morphology and migration data. Results: Metformin was lethal to half (LC₅₀) of the cells at 30 mM, and a decrease in viability (P<0.05) was noted at 5 mM. LECs in PCOM treated with 1 mM metformin showed increased Pax6 and E-cadherin and decreased α-SMA and fibronectin expression. LECs in PCOM treated with metformin also maintained epithelial morphology. Migration was inhibited with 0.5 mM metformin (P<0.05). Both HLE-B3 and the lens epithelium in donor eyes were found to express SLC22A1. Conclusion: Metformin decreased survival and migration in LECs, maintaining epithelial phenotype and reducing mesenchymal marker expression. Metformin therefore has potential as an adjunct in PCO prevention.

Purpose: To help the ophthalmologist in the study and update of the exciting area of ocular inflammation and uveitis. Concerning the most recent clinical entities, diagnostic techniques and therapeutic options, we propose a review of the main international journals: Ophthalmology, American Journal of Ophthalmology, Retina, Ocular Immunology and Inflammation and Journal of Ophthalmic Infection and Inflammation. Methods: A descriptive bibliographic review of the papers published in 2017 in the previously mentioned journals. Results: Sorted in the following categories: pediatric uveítis, scleritis, infectious uveítis, non-infectious uveítis, diagnostic and treatment, the main outcomes are analyzed. Conclusion: Last year 2017 offers numerous papers of the highest interest and relevance in the field of ocular inflammation and uveítis. Resumen Objetivo: Facilitar el estudio de las aportaciones más relevantes en el campo de la inflamación ocular y uveítis. Se propone una revisión de las principales revistas internacionales, incluyendo: Ophthalmology, American Journal of Ophthalmology, Retina, Ocular Inmunology and Inflammation y Journal of Ophthalmic Infection and Inflammation. Método: Revisión bibliográfica descriptiva de los artículos publicados durante el año 2017 en las revistas anteriormente citadas. Resultados: De forma narrativa, se analizan las categorías de uveítis pediátricas, escleritis, uveítis infecciosas, uveítis no infecciosas, diagnóstico y tratamiento. Conclusiones: El campo de la inflamación ocular y la uveítis evoluciona a gran velocidad, y durante el año 2017 hemos sido testigos de un gran número de publicaciones de alto impacto a nivel clínico, diagnóstico y terapéutico.

Purpose: We evaluate presenting features and treatment options of pediatric thyroid eye disease, and discuss the morbidity of this condition in the pediatric population. Methods: A retrospective chart review of 11 patients referred for evaluation of thyroid eye disease at a pediatric tertiary care facility in Miami, Florida. Results: The average age at presentation was 12.7 years. The most common ocular complaint was mild irritation. The average displacement on Hertel exophthalmometry was 21 mm for the right eye, and 21.45 mm for the left eye. Lower scleral show was the most common eyelid finding. Patients tended to be positive for thyroid stimulating immunoglobulin and thyroid peroxidase antibody. Conclusion: In contrast to thyroid eye disease in adults, the condition tends to present with mild ocular findings in children. Pediatric patients presenting with thyroid eye disease respond very well to medical therapy aimed at enhancing the altered ocular surface.

Viral conjunctivitis, mainly caused by Adenovirus, is currently a health problem to be solved. The increase in infection in recent years and the morbidity that can be associated despite treatment, make it an infectious disease whose knowledge and study is essential for the ophthalmologist. An exhaustive bibliographic review of the main articles published was carried out using the keywords: hemorrhagic conjunctivitis, epidemic keratoconjunctivitis, and adenovirus conjunctivitis, with the aim of discussing the main features, the new diagnostic methods, treatments, quitar and possible complications and clinical implications of the epidemic keratoconjunctivitis. Resumen La conjuntivitis viral, principalmente causada por Adenovirus, es actualmente un problema de salud a resolver. El aumento del contagio en los últimos años y la morbilidad que puede asociarse a pesar del tratamiento hacen que se trate de un cuadro infeccioso cuyo conocimiento y estudio es esencial para el oftalmólogo. Se realizó una revisión bibliográfica exhaustiva de los principales artículos publicados utilizando las palabras clave: conjuntivitis hemorrágica, queratoconjuntivitis epidémica y conjuntivitis por adenovirus, con el objetivo de discutir las principales características, los nuevos métodos de diagnósticos, tratamientos y posibles complicaciones e implicaciones clínicas de la queratoconjuntivitis epidémica.

This systematic review of biopsy proven cases of non specific orbital inflammation and sclerosing variant from 2010-2016 attempts to elucidate new findings regarding the demographic profile of the diseases. Discussion of histopathology is emphasized, as to describe the most common presenting features of non-specific orbital inflammation as well as to discuss its molecular profile. This review also discusses the therapeutic approach and discusses the “steroids vs. biopsy first” controversy regarding non-specific orbital inflammation. The incidence of IgG4 and its relationship to non-specific orbital inflammation is also discussed.

Diabetic macular edema (DME) is the most common cause of moderate visual loss in diabetic patients. The current treatment of choice for DME is anti-VEGF treatment. Even though recent clinical trials have shown that anti-VEGF treatment is superior to laser photocoagulation there are certain concerns regarding its sustainability over the long term. Most patients that undergo pharmacological inhibition with anti-VEGF agents need multiple monitoring visits that include OCT imaging and multiple injections. There is a theoretical concern regarding systemic thrombo-embolic events with chronic VEGF suppression. Pars plana vitrectomy (PPV) by increasing the vitreous cavity oxygenation, relieving vitreomacular traction and removing cytokines from the vitreous cavity may cause long term resolution of DME without the aforementioned concerns.

Leber's Hereditary Optic Neuropathy (LHON) is a mitochondrially inherited disorder characterized by rapid, subacute vision loss. LHON has historically been a difficult disease to study due to its low incidence. Many questions concerning its pathophysiology have remained unanswered. A significant enigma concerns LHON's gender bias as represented by the male-to-female ratio of about 4:1. Another source of confusion includes the variable penetrance, since the mitochondrial mutation is necessary, but not sufficient, to cause conversion. A third challenge involves the tissue specificity, since typically only the optic nerve is involved with a specific pattern of optic atrophy due to primary loss of the papillomacular bundle (PMB) in affected individuals. The fourth remaining complexity is the pattern of rapid, subacute vision loss observed in nearly all affected individuals. Several clinical genetic studies, cybrid experiments, and histochemical studies have been conducted to address the three enigmas of gender bias, variable penetrance, and tissue specificity. Despite elucidation of these three aspects of the pathophysiology, the mechanism behind the rapid, significant vision loss remains a mystery.

Introduction: Trabeculectomies are amongst the most common surgical procedures to lower intraocular pressure (IOP). Scleral flap dimensions are a key factor in influencing aqueous outflow and subsequent IOP reduction, especially in the early postoperative period. Despite the substantial diversity of scleral flap shapes that is used in practice, there is little information comparing outcomes between them. In this study, we review the literature on the uses and outcomes of various scleral flap shapes. Methods: A literature review was performed using the databases: MEDLINE, SCOPUS, and Web of Science. Search terms for relevant studies included the following: trabeculectomy AND (square OR triang* OR rectang* OR polygon* OR arc OR shape) AND flap. Results: Our initial literature search revealed 71 unique articles, six of which met our inclusion and exclusion criteria and were reviewed. Four articles reported the use of triangular flaps, one rectangular flap, one square flap, and two arc-shaped flaps. The data from each article were reviewed for the following:

1. Surgical technique;
2. Early postoperative intraocular pressure reduction;
3. Final postoperative intraocular pressure reduction;
4. Postoperative complications.

Conclusions: A myriad of scleral flap shapes is utilized in surgical practice. Essentially all of the trabeculectomy procedures, regardless of scleral flap shape, achieved substantial reductions in IOP with similar success rates. However, due to the variability in surgical technique and lack of direct comparison, we cannot definitively conclude or deny that one flap shape is superior to another. We believe our review provides the most comprehensive analysis of scleral flap shape to date and highlights its importance in regulating aqueous flow, especially in the early postoperative period.

We aimed to summarize the applications, strengths and weaknesses of two anterior segment imaging modalities: the ultrasound biomicroscopy (UBM) and the anterior segment optical coherence tomography (AS-OCT) in the diagnosis and surgical management of glaucoma. This narrative review was based on our clinical experience with these technologies supported on scientific literature review through Medline via PubMed®. The syntax used in the search was “Glaucoma AND Anterior Chamber Angle AND Ultrasound Biomicroscopy OR UBM AND Anterior Segment Optical Coherence Tomography OR AS-OCT”. Publications were selected based on relevance and no redundancy, and authorship from 2007-2014. Additionally, UBM and AS-OCT images were selected from two of the authors’ personal archives to illustrate prevalent glaucoma findings and post-operatory using both technologies. AS-OCT and UBM share overlapping characteristics and are both useful in glaucoma diagnosis and post-operative assessment. However, particular technical features of each will direct the best application to clarify specific glaucoma etiologies, to guide in the most effective management and to explain glaucoma surgical outcomes.

The purpose of this article is to review the plateau iris configuration demonstrating the importance of ultrasound biomicroscopy in the diagnosis. The possible non-pupillary block mechanism of angle-closure glaucoma and its management are also discussed. Resumen El objetivo de este trabajo es presentar una revisión de la configuración del iris en meseta demostrando la importancia de la biomicroscopía ultrasónica en el diagnóstico. También son discutidos los probables mecanismos del bloqueo no pupilar en el glaucoma de ángulo cerrado y su tratamiento.

While tearing patients have similar complaints, the etiology of their symptoms may vary widely and thus require a meticulous evaluation. A thorough history followed by systematic examination of the lids, ocular surface, anterior segment, and lacrimal system will lead the clinician to the proper diagnosis. Treatment options for lacrimal obstruction are varied and as surgical techniques continue to evolve, new studies are indicated to determine the approaches that provide the most successful outcomes while ensuring patient safety.

Anterior segment optical coherence tomography (OCT) is an innovative technique that provides detailed images of internal structures in biological tissues with a noncontact, noninvasive, high resolution exam for evaluation of anterior segment and ocular surface. This article reviews the fundamentals and clinical applications of OCT, considering relevant information about advantages and limitations, describing its role in the diagnosis, surgical planning and clinical evaluation of patients with a variety of conditions from anterior segment. We included images of clinical cases evaluated at the department of cornea and external diseases at UC Davis Medical Center, using high resolution spectral-domain OCT (Heidelberg Engineering GmbH. Germany) for the study of the anterior segment. Resumen La Tomografía de Coherencia Óptica (OCT) del segmento anterior de ojo es una innovadora técnica que provee imagen detallada de la estructura interna de tejidos biológicos con un examen no invasivo, sin contacto y de alta resolución, para la evaluación de segmento anterior y superficie ocular. Este artículo revisa los fundamentos y aplicaciones clínicas de OCT, considerando información relevante acerca de las ventajas, limitaciones y describiendo su rol en el diagnóstico, planificación quirúrgica y evaluación clínica de pacientes con una variedad de condiciones del segmento anterior. Hemos incluido imágenes de casos clínicos evaluados en el Departamento de córnea y enfermedades externas de UC Davis Medical Center, utilizando OCT Spectralis (Heidelberg Engineering GmbH. Germany), de alta resolución, para el estudio de segmento anterior.

Corneal allotransplantation has been the principal surgical treatment for vision loss caused by diseases of the cornea that result in scarring and opacification. Most authors define a “high-risk” cornea as that of a previously failed corneal graft or a cornea with vascularization in at least 2 quadrants. These high-risk corneal transplants have rejection rates approaching 70%, even with maximal local and systemic immune suppression. The management of high risk corneal transplants, which until recently was a slowly evolving field in ophthalmology, remains a highly controversial yet important topic. Management of these high-risk transplants has developed rapidly in the past 10 years. In this review, some of the challenges and controversies associated with high-risk corneal allotransplantation therapy will be discussed.

RESUMO A endoftalmite pós-operatória é uma infecção intraocular grave geralmente associada à cirurgia de catarata. Suas causas mais comuns são bactérias gram-positivas e gram-negativas, bactérias anaeróbias e fungos. Nos últimos anos, os resultados do tratamento das endoftalmites melhoraram mas a sua incidência ainda tem aumentado, apesar da adoção de importantes medidas preventivas pré, intra e pósoperatórias. Geralmente, o diagnóstico é clínico mas a avaliação laboratorial de amostras do humor vítreo é essencial para o isolamento do agente causal e para testes de sensibilidade antibiótica. A injeção intravítrea de antibióticos é a principal forma de tratamento e os corticóides também devem ser usados para ajudar a reduzir a inflamação intraocular. A vitrectomia via pars plana também é utilizada no tratamento da endoftalmite pós-operatória, principalmente se a visão é muito baixa ou se não há boa resposta com a terapia intravítrea inicial. O desenvolvimento futuro de novas formas de diagnóstico e tratamento além da observação rigorosa das medidas profiláticas são fundamentais para melhorar os resultados funcionais e diminuir a incidência desta grave infecção. ABSTRACT Postoperative endophthalmitis is a serious and sight-threatening intraocular infection most frequently associated with cataract surgery. The main causes of the infection are gram-positive and gram-negative bacteria, anaerobic bacteria and fungi. Lately, results of therapy for endophthalmitis have improved but its incidence is still increasing despite the adoption of important pre, intra and postoperative preventive measures. Diagnosis is usually based on clinical findings but laboratory work-up of vitreous specimens is essential for isolation of infecting organisms and antibiotic sensitivity tests. Intravitreal injection of antibiotics is the mainstay of treatment and steroids must also be used to help reducing intraocular inflammation. Pars plana vitrectomy is frequently performed for treatment of postoperative endophthalmitis, especially if vision is severely affected or if there is not a favorable response after initiation of intravitreal therapy. Future development of diagnostic and therapeutic models and rigorous observation of prophylactic standards are critical to optimize functional outcomes and to decrease the incidence of this severe infection.

Purpose: To evaluate the current preferences and trends of the vitreoretinal surgeons in Latin America regarding an open globe injury. Design: Internet based survey. Participants: The Pan-American Retina & Vitreous Society (PRVS), Venezuelan Society of Ophthalmology (VSO), and the Pan-American Collaborative Retina Study Group (PACORES) members participated. Methods: This questionnaire was sent by the principal investigator (JFA) to the PRVS, VSO, and PACORES' web lists with a total of 768 surveys sent. An ocular trauma case scenario was provided with a set of 8 questions related to that case. Results: Out of the 768 surveys sent, 38 (4.95%) physicians from 38 centers of 26 different cities in 13 countries of Latin America responded. The vast majority of consulted specialists do practice at a large city, and consider that severe ocular trauma cases are somewhat/very common in their locations. Most of the respondent surgeon's centers have surgical capability, 63% of them have a room staff available 24/7, most of them operate trauma cases, and 56% perform staged surgery. Half of the consulted specialists are satisfied with how eye trauma logistics are handled in their area. Conclusions: Those who perform the emergency intervention in big city centers have been trained adequately, and the responses were received mostly from trauma centers, with facilities outside regular business hours, allowing a complete approach (suturing plus vitrectomy if needed) of the injured patient. Our results seem to have a response bias as only 1 (2.7%) of the respondents was from a small city, and most of them were from trauma centers. Trauma cases may be referred from small cities to trauma centers in Latin America. Resumen Propósito: Evaluar las preferencias y tendencias actuales de los cirujanos de vítreo y retina en América Latina con respecto a un traumatismo ocular abierto. Diseño: Survey a través de Internet. Participantes: Los miembros de la Sociedad Panamericana de Retina y Vítreo (SPRV), la Sociedad Venezolana de Oftalmología (SVO), y el Grupo de Estudio Panamericano Colaborativo de Retina (PACORES) participaron. Métodos: El cuestionario fue enviado por el investigador principal (JFA) a través de las listas web de la SPRV, SVO y PACORES, con un total de 768 encuestas enviadas. Un escenario de un caso de trauma ocular fue provisto con ocho preguntas referentes a dicho caso. Resultados: De las 768 encuestas enviadas, respondieron 38 (4.95%) médicos de 38 centros de 26 diferentes ciudades en 13 países de Latinoamérica. La vasta mayoría de los especialistas consultados realizan su práctica en grandes ciudades, y consideran que los casos de trauma ocular severo son algo/bastante comunes en sus localidades. La mayoría de los centros de los cirujanos que respondieron cuentan con capacidad quirúrgica, 63% de éstos tienen un personal de emergencia disponible 24/7, la mayoría opera casos de trauma y el 56% realizan cirugía por estadíos. La mitad de los especialistas consultados están satisfechos con cómo la logística de trauma ocular es manejada en su área. Conclusiones: Aquellos que realizan intervenciones de emergencia en los centros de grandes ciudades han sido entrenados adecuadamente, y las respuestas fueron recibidas mayormente de centros de trauma, con servicio fuera de horario de oficina regular, permitiendo un abordaje completo (sutura más vitrectomía de ser necesario) del paciente traumatizado. Nuestros resultados parecen tener un sesgo en las respuestas, ya que sólo 1 (2,7%) de los encuestados que respondieron era de una ciudad pequeña y la mayoría de éstos eran de centros que manejan trauma. Los casos de trauma pudieran ser referidos de las ciudades pequeñas a los centros especializados en trauma en América Latina.

The tear film consists of three layers: an outer thin lipid layer that is composed in part of lipid-rich excreta called meibum, secreted by the meibomian glands; a middle aqueous-mucin layer that nourishes the cornea and conjunctiva; and an inner mucin layer that helps to spread the aqueous layer over the ocular surface. Changes in the quality or quantity of any of the tear film components affect its normal protective function and promote the development of dry eye disease. Currently, a study in the U.S estimated that 3.25 million women and 1.68 million men 50 years and older are affected, and is expected to grow even more. Previous studies have identified some risk factors for dry eye disease such as older age, female sex, reduced androgen levels, and imbalanced diet. Dry eye disease has been divided into two groups: 1) aqueous tear-deficient dry eye, and 2) evaporative dry eye (also known as lipid tear deficiency dry eye). Previous publications have postulated that an abnormal tear film lipid layer would facilitate the evaporation from the tear film and lead to the development of dry eye disease. In our study, using two relatives humidities (25-35% and 35-45%) we have reported an increase in the evaporation rate by 42.1% and 40% in dry eye patients, compared to normal group. These results indicate that the dry eye patients have a higher rate of evaporation from the aqueous tear layer as compared to normal subjects. The development of new technologies to reduce the evaporation from the aqueous tear has been the aim of many pharmaceutical companies. Newer lipid emulsion eye drops are becoming more effective and popular. Recent data suggest that after the instillation of these lipid-containing eye drops the lipid layer thickness and ocular symptoms improved in dry eye patients, compared to other commercially available eye drops. RESUMEN La superficie ocular está cubierta por una delgada película, llamada película lagrimal, compuesta por 3 capas: la externa o capa lipídica, integrada principalmente por los lípidos provenientes de las glándulas de meibomio; la capa intermedia, acuosa, compuesta por proteínas y electrólitos; y la capa interna, compuesta en su mayor parte de mucina. Cambios cuantitativos o cualitativos de cualquiera de los componentes de la película lagrimal conllevan a situaciones patológicas como el ojo seco. Actualmente, en Estados Unidos 3,25 millones de mujeres y 1,68 millones de hombres mayores de 50 anos se encuentran afectados, y esta cifra va en aumento. Estudios previos han identificado factores de riesgo para la enfermedad entre los que se encuentran el envejecimiento, sexo femenino, disminución de los niveles de andrógenos y dietas desbalanceadas. La enfermedad del ojo seco se divide en dos grupos: 1) ojo seco con deficiencia del componente acuoso, y 2) ojo seco de tipo evaporativo (también conocido como ojo seco con deficiencia del componente lipídico). Publicaciones previas han señalado el aumento de la evaporación de la película lagrimal en presencia de una capa lipídica disfuncional. Nuestras investigaciones (usando humedades relativas de 25-35% y 35-45%) han reportado un aumento en la evaporación de un 42.1% y 40% aproximadamente en pacientes con ojo seco, en comparación con el grupo control. Estos resultados indican que los pacientes con ojo seco tienen una tasa de evaporación de la película lagrimal mucho más alta a la de personas sanas. Cada día más laboratorios invierten en el desarrollo de tecnología para reducir la evaporación de la película lagrimal. Gotas con emulsión lipídica son cada vez más comunes y efectivas, estas gotas restauran parcialmente la capa lipídica y han demostrado ser eficaces en el tratamiento del ojo seco de tipo evaporativo en comparación con las gotas sin contenido lipídico.

RESUMO: Atualmente, os gases intraoculares são utilizados de rotina para o tratamento de várias doenças do segmento anterior e posterior, propiciando resultados melhores e mais rápidos. Os gases intravítreos são frequentemente usados para a terapia de descolamento de retina, buraco macular, hemorragia intravítrea e submacular e como coadjuvante em cirurgia vítrea. A aplicação de gases na câmara anterior é principalmente empregada no tratamento de hidrópsia corneana aguda, descolamento da membrana de Descemet e como adjuvante em ceratoplastia lamelar. Este artigo de revisão discute aspectos relacionados às atuais aplicações clínicas de gases para o tratamento de diferentes doenças oculares e também os possíveis efeitos adversos associados à injeção de gases na cavidade vítrea ou na câmara anterior. ABSTRACT: Intraocular gases in present day use are routinely implemented for therapy of several diseases of the anterior and posterior segment, leading to better and faster outcomes. Intravitreous gases are frequently used for therapy of retinal detachment, macular hole, intravitreous and submacular hemorrhage and as a coadjuvant during vitreous surgery. Intracameral gases are mainly employed for treatment of acute corneal hydrops, Descemet's membrane detachment and as adjuvant for lamellar keratoplasty. This review article discusses details concerning the current clinical applications of gases for treatment of different ocular diseases as well as the potential adverse events associated with gas injection in the vitreous cavity or in the anterior chamber.

The current study illustrates the evolution of the active uveitis found in 15 children two years after initiating treatment; the number of patients in whom the uveitis was treated and controlled; and the duration and the manner of treatment The evolution of other alterations found is also shown including synechiae, capsular opacities, band keratopathy and pathologic cataract, in the same time period. Resumen: En el presente trabajo se muestra la evolución de las uveítis en actividad hallada en estos 15 niños dos años después de iniciado el tratamiento; en cuántos pacientes se logró controlar y hacer desaparecer, en cuánto tiempo y cómo. Se muestra también la evolución de las otras alteraciones que se hallaron tales como sinequias, opacidades capsulares, queratopatía en banda y catarata patológica, en el mismo lapso.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause significant damage to the ocular surface and eyelids. The intense inflammation during the acute phase may lead to scarring sequelae and vision loss. Treatment of the chronic manifestations is challenging and only partially effective in many cases. Ophthalmologic evaluation and management during the acute phase is crucial in avoiding these problems. The evaluation and management of patients with SJS and TEN is described, with an emphasis on amniotic membrane transplantation as an effective means of limiting the acute phase damage.

Reconstruction of the anophthalmic socket has historically been and continues to be a unique surgical challenge. This article reviews recent advancements in the use of alloplastic materials, as well as exciting alternatives offered by several porous materials and resorbable implants. Resumo Apesar do tratamento da cavidade anoftálmica ser feito há muitos séculos, persiste até os dias atuais como um desafio. Este artigo apresenta uma revisão sobre o uso de materiais aloplásticos para a reparação da cavidade anoftálmica, abordando interessantes materiais porosos e reabsorvíveis para este fim.

The indication of the enucleation for choroidal melanoma, has abruptly reduce in the recent decades, due to a replacement for less aggressive treatments. All actual therapeutic alternatives are revised in relation to different publications which are focused in current treatment alternatives, this contains within its most important options Transpupillary Thermotherapy (TTT) for small melanomas, for medium melanomas braquitherapy (BT) or radiotherapy turns out to be very effective without differences as to the patient survival with regard to the enucleation. The local resections are an interesting indication for melanomas of anterior localization or with invasion to the ciliary body. It is important the combination of therapies to reduce tumor recurrences or to treat big sized melanomas with BT and TTT, local resection and TTT or BT. The enucleation is limited to big sized melanomas without visual possibilities or associated with complications such as neovascular glaucoma. We must also consider, some of the new concepts in the phato biology and genetic of the melanomas which will allow us to determine in the short run, a part of the treatment, the prognosis and the regular control in these patients. Resumen: La indicación de la enucleación para melanomas coroideos disminuyó radicalmente en las últimas décadas, debido al reemplazo por tratamientos conservadores. Todas las alternativas terapéuticas actuales son revisadas en relación a diversas publicaciones, que tiene dentro de sus opciones más importantes, Termoterapia Trans Pupilar (TTT) para melanomas pequeños, en los melanomas medianos la braquiterapia (BT) o radioterapia resulta altamente efectiva, sin diferencias en la sobrevida del paciente en relación a la enucleación. Las resecciones locales son una interesante indicación para melanomas de ubicación anterior o con compromiso del cuerpo ciliar. Es importante la combinación de terapéuticas para disminuir las recurrencias o para tratar melanomas de gran tamaño como la BT con TTT, resecciones locales con TTT o BT. La enucleación esta limitada a melanomas de gran tamaño, sin posibilidades visuales o asociados a complicaciones como el glaucoma neovascular. Consideraremos, algunos de los nuevos conceptos en la pato biología y genética de los melanomas que pensamos permitirá a corto plazo determinará en parte el tratamiento, el pronóstico y el seguimiento de estos pacientes.

Technological advances in the field of molecular biology and especially re-combinant DNA techniques have enabled scientists to develop gene therapy techniques for the treatment of human diseases. The potential therapeutic applications of gene transfer technology are enormous. The cornea is an excellent candidate for gene therapy because of its accessibility and immune-privileged nature. Studies examining the feasibility and optimal methods for vector-mediated gene transfer to the cornea have been performed using histochemical and fluorescent marker genes. These studies have utilized various viral vectors, such as adenovirus, adeno-associated virus, retrovirus, lentivirus, and herpes simplex virus, as well as non-viral methods to transfer heterologous genes into corneal cells in vitro, in vivo and ex vivo. In this review, we will discuss viral and non-viral approaches of gene delivery into the cornea as well as the limitations of these approaches. Additionally, we will discuss some potential applications for gene-based interventions which have been analyzed in specific corneal disorders such as allograft rejection, corneal wound healing, and corneal dystrophies using experimental models.