Diabetic retinopathy (DR) remains the major threat to sight in the working age population. Diabetic macular edema (DME) is a manifestation of DR that produces loss of central vision. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in diabetic patients. In PDR, the growth of new vessels from the retina or optic nerve, is thought to occur as a result of vascular endothelial growth factor (VEGF) release into the vitreous cavity as a response to ischemia. Furthermore, VEGF increases vessel permeability leading to deposition of proteins in the interstitium that facilitate the process of angiogenesis and macular edema. This review demonstrates multiple benefits of intravitreal bevacizumab on DR including DME and PDR. The results indicate that intravitreal bevacizumab injections may have a beneficial effect on macular thickness and visual acuity (VA), independent of the type of macular edema that is present. Therefore, in the future this new treatment modality could replace or complement focal/grid laser photocoagulation in DME. In addition, in PDR, this new option could be an adjuvant agent to pan-retinal photocoagulation so that more selective therapy may be applied.

Vascular endothelial growth factor (VEGF) plays an important role in many diseases of the posterior segment of the eye that are characterized by macular edema and intraocular neovascularization. Recently, anti-VEGF agents such as pegaptanib sodium and ranibizumab have been shown to be of benefit in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). However, in many parts of the world both pegaptanib sodium and ranibizumab are not readily available. Bevacizumab is a humanized recombinant monoclonal antibody against all VEGF isoforms. It has been proposed as an alternate treatment since it is more readily available. Since October 2005, investigators from Pan-American Collaborative Retina Study Group (PACORES) have tretaed patients with different vitreo-retinal pathologies with intravitreal bevacizumab. In our retrospective studies of relatively short follow-up, we have observed both functional and anatomic improvements in an important group of patients with diseases such as CNV secondary to different etiologies such as myopia and AMD, diabetic macular edema, as an adjuvant in proliferative diabetic retinopathy, macular edema secondary to venous vascular occlusions and pseudo-phakic cystoid macular edema. We believe that our results are promising. However, further studies are needed to determine the dose, injection interval, the number of injections and the long term safely, among other issues. El factor de crecimiento vascular endotelial (VEGF por sus en inglés, Vascular Endothelial Growth Factor) juega un papel importante en muchas enfermedades del segmento posterior que se caracterizan por edema macular y neovascularización intraocular. Recientemente, se ha demostrado la eficacia de fármacos anti-VEGF como el ranibizumab y el pegaptabib sodio en la neovascularización coroidea (NVC) secundaria a la degeneración macular relacionada a la edad (DMRE). Sin embargo en muchas partes del mundo, tanto el pegaptanib sodio como el ranibizumab no se encuentran fácilmente disponibles. El bevacizumab es un anticuerpo monoclonal recombinado humanizado que se adhiere e inhibe todas las isoformas del VEGF. Este se ha propuesto como un tratamiento alternativo ya que es fácil de obtener. Desde octubre del 2005, los investigadores del grupo PACORES (Pan-American Collaborative Retina Study Group) hemos utilizado el bevacizumab intra-vítreo en diferentes patologías vitreoretinianas. En nuestros estudios retrospectivos de seguimiento relativamente corto, hemos observado mejoría anatómica y funcional en un grupo importante de pacientes con patologías como la NVC secundaria a diferentes etiologías incluyendo la DMRE y miopía, edema macular diabético, como adyuvante en la retinopatía diabética proliferativa (RDP), edemas maculares secundarios a oclusiones retinales venosas y edema macular cistoideo pseudofáquico. Creemos que los resultados son prometedores pero se requieren de más estudios para determinar la dosis, el intervalo entre tratamientos, el número de tratamientos y la seguridad a largo plazo entre otras consideraciones.

HSV stromal keratitis is a frequent cause of ocular and visual morbidity. There are three recognized clinical forms: interstitial, disciform (endotheliitis), and necrotizing stromal keratitis, which all differ clinically as well as pathophysiologically. Although treatment for epithelial HSV keratitis has been standardized, it still remains controversial for the stromal form. The goal and challenge in the treatment lies in the balance of the inflammation generated by the host's immune system, and the infection from the virus. Several studies, including the cornerstone HEDS studies, consolidated the benefit of combined corticosteroid and antiviral therapy in the treatment of all forms of HSV stromal keratitis. Most studies used topical trifluridine as antiviral of choice, however several studies have demonstrated that oral acyclovir (or valacyclovir) along with topical corticosteroids is an equivalent and effective therapy, and avoids the often underestimated epithelial toxicity of long-term topical trifluridine. Prophylaxis from recurrences with oral acyclovir (or valacyclovir) is essential in the management of these patients due to the frequent relapses and its consequence on visual prognosis.

Objective: To evaluate the efficacy of topical anesthesia and topical + intracameral anesthesia in phacoemulsification of different opacity grade cataracts. Material and Methods: 128 patients underwent with phacoemulsification and foldable intraocular lens implantation. The patients were divided into two groups: topical anesthesia only (n=64) and topical + intracameral anesthesia (n=64) with preservative free 1% lidocaine added to the infusion solution. Cataract opacity grade, intra-operative and immediate post-operative pain as well as vital signs were recorded. Results: Mean age of 68.4 years ± 2.7 D (49-90), 67 females (52.34%) and 61 males (47.66%). Cataract opacity grades were as follows: II (18%), III (61.7%), IV and greater (20.3%). Thirteen patients experienced mild pain: 9 (7%) in the topical anesthesia group during nuclear rotation and 4 (3%) in the topical + intracameral anesthesia group during insertion of the phaco needle into the anterior chamber. (p= 0.14) Vital signs were stable. Conclusion: Topical anesthesia is both safe and effective in phacoemulsification. Topical + intracameral anesthesia is more appropriate for cases with cataracts of greater density. RESUMEN Objetivo: Evaluar la efectividad de la anestesia tópica sola y anestesia tópica e intracameral en diferentes grados de cataratas tratadas con facoemulsificación. Material y Método: Se revisaron 128 pacientes con catarata y sometidos a facoemulsificación e implante de lente intraocular plegable. Se dividieron en dos grupos: grupo de anestesia tópica (n=64) y grupo de anestesia tópica e intracameral (n=64) con lidocaína al 1% libre de conservadores administrada a la infusión de irrigación. Se registraron tipo de catarata, dolor trans y post operatorio inmediato y signos vitales. Resultados: La edad media fue de 68.4 ± 2.7 D (49-90), 67 mujeres (52.34%) y 61 hombres (47.66%). Las cataratas se distribuyeron en los siguientes grados: II (18%), III (61.7%), IV y mayor (20.3%). Trece pacientes presentaron leve dolor, 9 (7%) del grupo con anestesia tópica al rotar el núcleo en cataratas grado IV y 4 (3%) en el grupo de tópica e intracameral, durante la introducción de la pieza de mano a la cámara anterior. (p=0.14) Signos vitales eran estables. Conclusión: La anestesia tópica es segura y efectiva en facoemulsificación, la anestesia tópica e intracameral es mejor en casos de catarata de mayor densidad

Se realiza un estudio descriptivo prospectivo con un grupo de 45 pacientes remitidos por primera vez a nuestro servicio, portadores de algunas de las enfermedades reumáticas. De ellos 37 (82%), presentaban o habían presentado en algún momento uveítis anterior u otros tipos de alteraciones del segmento anterior. Se halla igual número de casos para ambos sexos y el 20% era menor de 5 años. Estos pacientes en su gran mayoría no presentaron, ni síntomas ni signos que hicieran sospechar que se estaba desarrollando una enfermedad ocular. La mayoría tenía diagnóstico de Artritis Idiopática Juvenil. Los hallazgos más relevantes en la lámpara de hendidura fueron la presencia de pigmentos y sinequias. Todos los casos recibieron tratamiento local, asociado o no a tratamiento sistémico (esteroide y/o inmunosupresor). La evolución fue satisfactoria en la mayoría de los pacientes.