Pressure to practice evidence-based medicine is increasing and has the potential to reduce malpractice claims. Sometimes the evidence may prove a specific therapy to be ineffective, but practice says it is effective. In Medicine, however, if you do not trust the evidence, you may expose yourself and your patients to untoward consequences. When we face a complex problem, most of the time it is better to rely on scientific evidence rather than on expert personal opinion.

Ocular surface squamous neoplasia (OSSN) encompasses a range of corneal and conjunctival lesions from intraepithelial dysplasia to invasive squamous cell carcinoma. The mainstay of treatment for OSSN has traditionally been surgical excision with wide margins and cryotherapy. Increasing evidence on the efficacy and safety of medical therapy and the avoidance of surgical complications has made topical chemotherapy increasingly popular among corneal specialists. The most common topical agents used for the treatment of OSSN include mitomycin C, 5-fluorouracil, and interferon α2b. Herein, we review recent advances in the surgical and medical management of OSSN and discuss advantages and disadvantages of each approach. The role of ultra high-resolution optical coherence tomography in the diagnosis and treatment of primary and recurrent OSSN lesions is also discussed.

Acanthamoeba keratitis is a sight-threatening disease that carries a favorable prognosis when diagnosed and treated early in the disease course. In some countries, the disease is more common than fungal keratitis, thus showing the importance of knowing and understanding this intriguing infection.

Currently, there are no level one evidence-based studies comparing systemic vs topical therapy for the management of fungal keratitis. Information on systemic efficacy alone or in combination with topical use is rare. Selection of the most appropriate antifungal for fungal keratitis remains a challenge, hindered by the diverse clinical presentation in fungal keratitis, delay in clinical and laboratory diagnosis, limited supply of effective antifungals, lack of ocular pharmacological profiles for current antifungals, nonstandard dosing intervals/routes of administrations, expanding list of causative agents, geographic diversity and the emergence of resistance. Efficacy is gleamed from personal observations, clinical experience, literature reviews, or retrospective data from small or single cases studies and or chart reviews. Taken together, the level of existing evidence is insufficient to determine the role of systemic vs topical therapy for fungal keratitis. Topical therapy remains the standard for treatment of fungal keratitis. Adjunctive therapy with oral or intravenous antifungals may be required for severe or recalcitrant ulcers. Well-powered randomized clinical trials involving diverse and common topical vs systemic therapies are needed to address this question.

Bacterial keratitis (BK) is one of the most frequent causes for emergency hospital admissions.¹ Identifying the causative microorganism promptly and properly is mandatory to achieve acceptable outcomes. Nevertheless, appropriate initial management of these cases requires laboratory-based diagnosis and even a modest laboratory set may not always be available at some clinical settings.

Blepharitis is one of the most common disorders encountered in ophthalmology. Despite this, it can often be overlooked and misdiagnosed. Blepharitis can manifest as anterior and/or posterior disease. The form of blepharitis can be determined based on patient symptoms or clinical presentation. An appropriate treatment plan can be made once the form of blepharitis is elucidated. Three key strategies should be addressed in the treatment of blepharitis: (1) management of symptoms, (2) control of any inflammation that is present to prevent long-term damage, and (3) prevention of recurrence. This review focuses on the treatment of this disease as well as suggestions for treating the most severe cases while keeping these goals in mind.

Resumen Los nevus coroideos son lesiones benignas las mismas se deben diferencias de lesiones malignas o sospechosas de malignidad de localización coroidea. En porcentaje relativamente bajo puede sufrir la transformación a melanoma corideo por lo cual no solo el diagnostico sino también el seguimiento resultan claves en estas lesiones. Se revisan las características de los nevus coroideos considerando: definición, epidemiología, patología, características clínicas, exámenes complementarios, tratamientos y pronóstico. Se resumen los puntos clave en cada unos de los tópicos con el objetivo de permitir la rápida revison para oftalmólogo general y en formación.

Corneal and conjunctiva intraepithelial neoplasias (CIN) and squamous cell carcinoma (SCC) are the most common non-pigmented ocular surface tumors. The main clinical manifestations are: foreign body sensation, ocular irritation, and conjunctiva hyperemia. CIN and SCC can be diagnosed clinically and confirmed by histopathology. The treatment is historically done by surgery and cryotherapy. Over the last decade, medical treatment has become more common. Medical treatment can be done using Mitomycin-C (MMC), 5–fluorouracil or interferon alpha-2b. The patient can also use more the topical treatment as an adjuvant therapy. If a recurrence occurs a new cycle of the same agent or a different one can be used. All patients need to be followed even after complete cure. The possibility of recurrence is always present. Resumo Neoplasia intra-epitelial córneo-conjuntival (NIC) e carcinoma escamoso córneo-conjuntival (CEC) representam juntos as neoplasias mais comuns da superfície ocular. As principais manifestações clínicas são: sensação de corpo estranho, irritação ocular, hiperemia conjuntival. O diagnóstico de CEC/NIC pode ser clínico ou confirmado por exame anátomopatológico. O tratamento historicamente e realizado através de ressecção cirúrgica e crioterapia. Nas ultimas décadas a opção de tratamento tópica vem se tornando mais comum e disponível em diversas regiões. Este tratamento tópico pode ser realizado com mitomicina C, interferon alfa-2B, 5 fluoracil. Ou ainda podem ser utilizados mais de um agente no mesmo paciente, ou ser uma terapia coadjuvante no tratamento destas doenças. A recorrência após o uso de agentes tópicos é menor do que a dos casos cirúrgicos e pode ser tratada com novos ciclos do mesmo agente ou com uma droga diferente. A freqüência de acompanhamentos depende do tipo de lesão do pacientes, mas todos devem ser acompanhados mesmo apos a cura. Apesar de se tratar de um tumor com baixo potencial de malignidade, esta não pode ser descartada, além da possibilidade de aparecimento de recorrência ou tumores em outros locais.

Currently diabetic eyes represent an important proportion of eyes that undergo cataract extraction. Previously, diabetic patients were told to delay cataract extraction as long as possible since cataract surgery was associated with a worse visual outcome. However, more recent studies have suggested that complications arising from modern small incision phacoemulsification with foldable intraocular lens implant are very few, in particular in eyes with no diabetic retinopathy or mild non proliferative diabetic retinopathy. These studies suggest that the progression in diabetic retinopathy seen following cataract extraction are the result of the natural history of the disease rather than an effect of the cataract surgery. The most important determinants of a progression in diabetic retinopathy are the pre-operative degree of severity of diabetic retinopathy and the presence or absence of diabetic macular edema. Therefore we recommend early phacoemulsification in patients with no diabetic retinopathy or mild-moderate non proliferative diabetic retinopathy. Eyes with diabetic macular edema, severe non proliferative diabetic retinopathy and pro-liferative diabetic retinopathy need to be treated prior to cataract extraction. Resumen Hoy en día, los pacientes diabéticos representan una importante proporción de los ojos que se someten diariamente a una extracción de catarata. Previamente se habia recomendado esperar lo máximo posible antes de una extracción de catarata ya que la cirugía de catarata estaba asociada a la progresión de la retinopatía diabética, en particular al edema macular diabético. Sin embargo, estudios más recientes han sugerido que con las técnicas modernas de facoemulsificación de incisión pequeña con implante plegable, las complicaciones son mínimas, particularmente en ojos sin retinopatía diabética o retinopatía diabética no proliferativa leve. Sugieren que la progresión que se observa en ojos diabéticos sometidos a extracción de catarata son el resultado de la historia natural de la retinopatía diabética y no al efecto de la cirugía. Los determinantes de una progresión post-operatoria de la retinopatía diabética son el grado de retinopatía diabética pre-operatoria y la presencia o ausencia de edema macular diabético. Por lo tanto recomendamos una facoemulsificación precoz en estadíos iniciales de la retinopatía diabética. El edema macular diabético, la retinopatía diabética no proliferativa severa y retinopatía diabética proliferativa pre-operatorias deben de tratarse antes de considerar una extracción de catarata.

Lamellar keratoplasty has seen a resurgence in the new millennium from an era where penetrating keratoplasty has become the gold standard for surgical treatment for corneal disorders. We provide a historical review of keratoplasty and discuss various techniques of deep anterior lamellar keratoplasty (DALK). Resumen La queratoplastía lamelar ha renacido en el nuevo milenio tras una era en la que la queratoplastía penetrante se convirtió en el estándar de oro para el tratamiento de patología corneal. Realizamos una revisión histórica queratoplastía y discutimos varias técnicas de queratoplastía lamelar anterior profunda (de sus siglas en ingles: DALK).

The management of severe ocular surface disease (OSD) has benefited from major breakthroughs in recent years. Previously, patients with severe ocular surface disease had a poor prognosis. Advances in micro-surgical techniques and understanding the role of limbal stem cells have led to great improvements in both of visual acuity and quality of life of these patients by using limbal cell transplantation techniques. The management of severe ocular surface disease (OSD) has benefited from major breakthroughs in recent years. Previously, patients with severe ocular surface disease had a poor prognosis. Advances in micro-surgical techniques and understanding the role of limbal stem cells have led to great improvements in both of visual acuity and quality of life of these patients by using limbal cell transplantation techniques. Resumen El tratamiento de la enfermedad de la superficie ocular (OSD por sus siglas en inglés, Ocular Surface Disease) se ha beneficiado debido a los grandes avances en los últimos años. Anteriormente, los pacientes afectados con la enfermedad de la superficie ocular presentaban un mal pronóstico. Los avances en la técnica del tratamiento micro quirúrgico y la compresión del importante papel que juegan las células madres del limbo han demostrado una mejoría en la agudeza visual y la calidad de vida del paciente por el uso del trasplante de células limbares.