A 53-year-old man with a history of multiple cutaneous facial squamous cell carcinoma (SCC) presents with a progressively enlarging cystic mass of his right brow for two months associated with periocular pain and numbness along the right side of his scalp. In addition, several subcutaneous lesions were noticed along the nasolabial and nasojugal areas. All lesions were excised and confirmed to be SCC on pathology with perineural spread observed with the primary brow lesion. The presence of a cystic lesion and/or multiple subcutaneous lesions should prompt consideration of a metastatic presentation of SCC. Furthermore perineural invasion of SCC can be associated with sensory and/or motor deficits.

Purpose: To describe five cases (four children) with ocular sequelae from honeybee or wasp sting injuries to the eye treated with anterior chamber irrigation to reduce venom concentration and subsequent complications. Design: Interventional case series. Methods: Patients with hymenoptera corneal sting injuries were treated in the operating room by performing an anterior chamber irrigation with balanced saline solution and triamcinolone in an effort to minimize the tissue damage induced by bee venom. Results: Early clearing of inflammation and more rapid recovery of baseline acuity were associated with early surgical intervention. Late complications included corneal decompensation, iris heterochromia, paralytic mydriasis, glaucoma and cataract; these complications are irreversible and sight threatening. Conclusion: Performing an early anterior chamber irrigation is a treatment option for this type of trauma, since it results in faster resolution and fewer late complications.

Purpose: We review a case of invasive squamous cell carcinoma invading the cornea to discuss optimal management. Methods: Observational case report with histopathologic analysis. Results: Histopathology demonstrates corneal invasion by the tumor that appears to have been completely excised with a large therapeutic keratoplasty and adjuvant cryotherapy. Conclusions: Successful management of ocular surface squamous neoplasia (OSSN) requires removal of identifiably abnormal tissue without disruption of normal protective architecture, careful histopathologic analysis, and the employment of adjuvant therapy at the time of or subsequent to surgical excision.

Purpose: To establish the correlation between morphometric corneal changes and the magnitude of the ametropia treated by excimer laser (LASIK) until the year of the surgery. Design: Observational, descriptive, longitudinal and prospective investigation Method: The studied group was comprised of 78 patients (151 eyes) operated with LASIK with a pendular microkeratome at the Abel Santamaría Hospital of November from November 2010 to June of 2011. Confocal microscopy with ConfoScan 4 (NIDEK) was performed for obtaining and studying the live corneal tissue images. Automatic scans were programmed with central fixation, speed of acquisition of the image to 25 images per second, magnification of 500x, lateral resolution of 0.6 µm/pix, with 350 images for scan, and distances of work of 1,98 mm. Statistical analysis of the variables was done by descriptive statistic, Pearson's correlation test and linear regression. Results: After LASIK, a significant statistic correlation was found on the magnitude of the treated ametropia with the following variables: epithelial thickness, pachymetry, stromal residual bed and keratocyte density in the posterior flap or in the retroablation zone. Conclusions: The higher the magnitude of the ametropia treated with LASIK, the greater the increase in the epithelial thickness in the first half of the postoperative period and, the lower the values of pachymetry, and residual stromal bed, keratocytes density on both sides of the lamellar flap, after one year of treatment. Resumen Objetivo: Establecer la correlación entre los cambios morfométricos corneales y la magnitud de la ametropía tratada hasta el año de cirugía corneal con láser de excímeros por la técnica LASIK. Diseño: Investigación observacional, descriptiva, longitudinal y prospectiva. Método: La muestra quedó constituida por 78 pacientes (151 ojos) operados con LASIK con microque-rátomo pendular en el Hospital Abel Santamaría Cuadrado en Pinar del Río de noviembre de 2010 a junio de 2011. Se utilizó el microscopio confocal ConfoScan 4 de NIDEK para la obtención y estudio de las imágenes in vivo del tejido corneal. Se programó en modo escaneo automático, con fijación central, velocidad de adquisición de la imagen a 25 imágenes por segundo, magnificación de 500x, resolución lateral de 0.6 µm/píxel, con 350 imágenes por escaneo, distancia de trabajo de 1,98 mm. Se utilizaron métodos de estadística descriptiva, correlación de Pearson y regresión lineal. Resultados: Se obtuvo posterior a LASIK correlación estadísticamente significativa entre la magnitud de la ametropía tratada y las variables grosor epitelial, paquimetría, lecho estromal residual y densidad de queratocitos en subcapas flap posterior y retroablación anterior. Conclusiones: Mientras mayor es la magnitud de la ametropía tratada con LASIK, mayor es el aumento del grosor epitelial en el primer semestre de postope-ratorio y menores los valores de paquimetría, lecho estromal residual y densidad queratocitaria a ambos lados del corte lamelar, al año de tratamiento. Key words: LASIK, Morfometría, cornea, microscopy confocal.

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.

Purpose: To present three male patients with subfoveal perfluorocarbon liquid after surgery for retinal detachment with macular involvement. Design: Interventional case series. Methods: Perfluorocarbon liquid extraction was performed by retinotomy and aspiration with a 25 or 38 gauge cannula. Results: Four months later, anatomic restoration was achieved, without rests of perfluorocarbon liquid, but with a severe defect in photoreceptors. Visual acuity remained unchanged. Conclusion: Subfoveal perfluorocarbon liquid extraction in patients with previous surgery of retinal detachment with macular involvement may imply bad functional outcomes, probably due to a previous damage of pigment epithelium and photoreceptors, aggravated by perfluorocarbon liquid toxicity. Resumen Objetivo: Presentar tres varones entre 43 y 63 años, con presencia de perfluorocarbono líquido subfo-veal tras cirugía de desprendimiento de retina con afectación macular. Métodos: Se realizó extracción mediante retinoto-mía y aspiración con cánula de 25 o 38 gauge. Resultados: A los 4 meses, se consiguió restauración anatómica, sin restos de perfluorocarbono líquido subfoveal, pero con defecto severo en los fotorreceptores. La agudeza visual no experimentó cambios significativos. Conclusión: La extracción de perfluorocarbono líquido subfoveal en pacientes intervenidos previamente de desprendimiento de retina con afectación macular suele conllevar un mal pronóstico funcional, posiblemente en relación con un daño previo de las células del epitelio pigmentario y los fotorreceptores, agravado por la toxicidad del perfluorocarbono líquido.

Combined venous lymphatic malformation is a benign, nonhereditary vascular anomaly. These unencapsulated hamartomas can be associated with spontaneous, recurrent hemorrhage leading to prop-tosis and pain. We describe a patient with this lesion to discuss the various management strategies and surgical challenges encountered with this condition.

Purpose: To evaluate the torsional effect of superior oblique muscle tenectomy. Design: Case report. Methods: Case report of a patient with horizontal strabismus and bilateral superior oblique muscle overaction, submitted to bilateral superior oblique tenectomy. Objective access of ocular torsion was performed using retinogra-phy and a computer software (Autocad 2009®). Results: The preoperative angle was 7.57 in the right eye and 0.66 in the left eye. Postoperative angle of torsion was 4.22 in the right eye and -1.50 the left eye. Conclusion: The presented case report suggests that superior oblique tenectomy has an extortion effect, decreasing the intorsion detected in case of superior oblique overaction. Resumo Objetivo: Avaliar objetivamente o efeito torcional da tenectomia do músculo oblíquo superior. Desenho: Relato de caso. Métodos: Estudo de paciente portador de estrabismo horizontal e hiperfungào bilateral dos oblíquos superiores, submetido à tenectomia bilateral. A medida objetiva da to-rgào ocular foi realizada mediante exame retinográfico e de um programa de computador (Autocad 2009®). Resultados: O ángulo de torgáo no período pré-operatòrio era de 7,57° no olho direito e de 0,66° no olho esquerdo. No período pòs-operatòrio, o ángulo de torgáo encontrado foi de 4,22° no olho direito e -1,50° no olho esquerdo. Conclusáo: O presente estudo suge-re que a tenectomia do músculo oblíquo superior tem efeito extorsor, diminuindo a intorgáo encontrada nos casos de hiperfungáo deste músculo.

Purpose: To describe surgical outcomes and the resulting fusion and stereopsis in patients submitted to surgery of congenital esotropia and its relationship with the surgical timing. Design: Interventional case series Methods: We performed a study in patients submitted to the surgery of congenital esotropia in the Pediatric Ophthalmology Service of the Cuban Ophthal-mological Institute Ramón Pando Ferrer”, from January 2007 to May 2010. The following variables were analyzed: preoperative angle of deviation, postoperative ocular alignment, ocular alignment stability, surgical timing, fusion and stereopsis. Results: In 96% of the cases, orthotropy or aesthetically acceptable alignment at 8 weeks after surgery was achieved. Moreover, 73% maintained this alignment after one year of the surgery. 57.7 % of the patients got fusion and 30.8 % achieved stereopsis, in a range of 3000 at 400”. Children over 18 months old had a risk five times bigger of not developing fusion and four times bigger of not developing stereopsis than those operated before that age. Conclusions: Early surgery is important to improve the visual functional results in patients with congenital esotropia. RESUMEN Objetivo: Describir los resultados quirúrgicos y la obtención de fusión y estereopsia en operados de esotropía congénita y su relación con la edad quirúrgica. Diseño: Serie intervencional de casos. Método: Estudio de serie de casos, en pacientes operados de esotropía congénita en el servicio de Oftalmología Pediátrica del Instituto Cubano de Oftalmología “Ramón Pando Ferrer”, en el período comprendido entre enero del 2007 a mayo del 2010. Se analizaron las siguientes variables: ángulo de desviación preoperatorio, alineamiento ocular postoperatorio, estabilidad del alineamiento ocular, edad quirúrgica, fusión y estereopsia. Resultados: En el 96% de los casos se logró orto-tropía o alineamiento estéticamente aceptable a las ocho semanas del post operatorio y al año de la cirugía el 73% mantuvo este alineamiento. El 57,7% de los pacientes alcanzó fusión y el 30,8 % logró estereopsia, en un rango de 3000 a 400”. Los niños operados después de los 18 meses tuvieron un riesgo cinco veces mayor de no desarrollar fusión y cuatro veces mayor de no desarrollar estereopsia que los operados antes de esa edad. Conclusiones: La cirugía temprana resulta importante para mejorar los resultados funcionales visuales en los operados de esotropía congénita.

Purpose: To assess sensibility and specificity, positive and negative predictive values and probability of false-positive and false-negative of the water-drinking test, ibopamine test, frequency doubling perimetry, short-wave automated perimetry and daily curve of intraocular pressure in glaucoma suspects. Design: Cross-sectional study Methods: Glaucoma suspect eyes and normal control eyes from age-matched individuals, both with normal standard achromatic perimetry, were submitted to water-drinking test, ibopamine test, frequency doubling perimetry, short-wave automated perimetry and daily curve of intraocular pressure. Results: We included 45 Glaucoma suspect and 30 normal control eyes. Sensibility and specificity were respectively 75.6% and 100% for daily curve of intraocular pressure; 35.6% and 80% for ibopamine test; 22.2% and 96.7% for short-wave automated peri-metry; 15.6% and 96.7% for water-drinking test; 8.9% and 100% for frequency doubling perimetry. Positive and negative predictive values of the same workups were: 100% and 99.5%; 3.5% and 98.4%; 12% and 98.4%; 8.7% and 98.2%; 100% and 98.2%. False-positive and false-negative probabilities were: 0% and 0.5%; 96.5% and 1.6%; 91.3% and 0%; 88.0% and 1.6%; 0% and 1.9%. Conclusions: The daily curve of intraocular pressure presented the highest sensibility with the highest positive predictive value. Frequency doubling perime-try presented a very low probability of false-negative. Ibopamine test, water-drinking test and short-wave automated perimetry presented a very high probability of false-positive.

Vascular endothelial growth factor (VEGF) plays a major role in the patho-genesis of diabetic retinopathy. Its inhibition by bevacizumab, a monoclonal antibody against all VEGF isoforms, has been shown to be beneficial in the management of both diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Our group has previously demonstrated that multiple intra-vitreal injections of bevacizumab of either 1.25 or 2.5 mg in eyes with DME result in a reduction of macular edema and an improvement in visual acuity. We did not observe any differences in the outcomes between eyes treated with the lower and higher doses of bevacizumab. We also studied the effect of intravitreal bevacizumab in eyes with PDR. Intravitreal bevacizumab is capable of inducing regression of retinal and optic disc neovascularization. However this regression is not permanent and panretinal photocoagulation is needed to consolidate treatment. Caution should be exercised in eyes with advanced PDR since a rapid involution of the fibrovascular proliferation may lead to the development or the progression of a tractional retinal detachment. Thus when using intravitreal be-vacizumab as an adjuvant in diabetic vitrectomies, surgery should be scheduled no more than 4 days after injection. Resumen El factor de crecimiento vascular endotelial (VEGF) juega un rol protagónico en la patogénesis de la retino-patía diabética. Su inhibición por el Bevacizumab, un anticuerpo monoclonal contra todas las isoformas del VEGF, ha demostrado ser benéfica en el manejo tanto del edema macular diabético (EMD) como de la retinopatía diabética proliferativa (RDP). Nuestro grupo ha previamente demostrado que múltiples inyecciones intravítreas tanto de 1,25 o 2,5 mg de bevacizumab en ojos con EMD resultan en la reducción del edema macular y mejoría en la agudeza visual. No se observó diferencia alguna entre los resultados de los ojos tratados con dosis más bajas o altas del bevacizumab. Se estudió también el efecto del bevacizumab intravítreos en ojos con RDP. El bevacizumab intravítreo es capaz de inducir regresión de la neovascularización de la retina y disco óptico. Sin embargo, esta regresión no es permanente y la fotocoagulación panretiniana o vitrectomía son ne-cesarías para consolidar el tratamiento. Se debe tener cautela en ojos con RDP avanzada debido a que la rápida involución de las proliferaciones fibrovasculares pueden conllevar al desarrollo o progresión de un desprendimiento de retina traccional. Por lo tanto al utilizar el bevacizumab intravítreo como adyuvante en la vitrectomía de pacientes diabéticos, la cirugía no debe ser programada más de 4 días después de dicha inyección.

Purpose: To report a quick reopening of a spontaneously closed full thickness macular hole. Design: Case report. Methods: A 68-year-old patient with stage III full thickness idiopathic macular hole in one eye was followed up for thirteen months with fundus photography and optical coherence tomography (OCT). Results: Twelve days after the first examination, that detected the macular hole, OCT scans revealed the closure of the macular hole associated to the development of a small epiretinal membrane (ERM). One month later, the patient was admitted to the emergency unit, complaining of progressive visual loss over the past three days. OCT examination showed a full-thickness macular hole, very similar to the previously closed, and a progression of the ERM. The patient was submitted to pars plana vitrectomy with internal limiting membrane peeling and removal of ERM. Surgical repair resulted in significant functional and anatomic outcome. Conclusion: The reopening of a spontaneously closed macular hole is remarkably uncommon and has been reported previously in two patients. A rigorous follow-up is mandatory, because these macular holes can quickly reopen, as demonstrated in this case report. RESUMEN Propósito: describir un caso de rápida reapertura tras cierre espontáneo de un agujero macular de espesor completo. Diseño: caso clínico. Métodos: Paciente de 69 años con agujero macular de espesor completo estadío III en un ojo que es seguido durante 14 meses mediante retinografías y tomografía de coherencia óptica (OCT). Resultados: Doce días tras la exploración inicial, los cortes de la OCT revelaron el cierre del agujero macular asociado al desarrollo de una pequeña membrana epiretiniana (MER). Un mes más tarde, el paciente acudió a urgencias por disminución de agudeza visual progresiva desde hacía tres días. La exploración mediante OCT mostró un agujero macular de espesor completo, muy similar al que previamente se había cerrado, y una progresión de la MER. El paciente fue sometido a vitrectomía pars plana (VPP) con pelado de membrana limitante interna y remoción de MER. La cirugía resultó en buenos resultados anatómicos y funcionales. Conclusión: La reapertura tras cierre espontáneo de un agujero macular es muy infrecuente y ha sido descrita en tan solo dos casos hasta ahora. Es necesario un seguimiento estrecho, pues estos agujeros pueden reabrirse rápidamente, como mostramos en este caso.

Microphthalmos with orbital cyst is a rare and severe non-hereditary ocular developmental anomaly. Pathologically it represents a failure in the closure of the embryonic fissure at the 7-14 mm stage of gestation, resulting in a congenital microphthalmia and the formation of a colobomatous cyst in different degrees. We present a patient with this condition to emphasize the complexity in the decision making process and review the various management strategies to obtain the best long term results. RESUMEN Microftalmos con quiste orbital es una rara y grave anomalía ocular no-hereditaria del desarrollo. Patológicamente representa una falla en el cierre de la fisura embrionaria en la fase de 7-14 mm de gestación, resultando en una microftalmía congénita y la formación de un quiste colobomatous en diferentes grados. Presentamos a un paciente con esta condición para enfatizar la complejidad en la toma de decisiones en el proceso y revisar las diferentes estrategias de manejo para obtener los mejores resultados a largo plazo.

We report the management of a non-traumatic rhegmatogenous retinal detachment in a pediatric patient in the context of a genetic syndrome associated with failure of type 2 collagen synthesis, which manifests itself in ocular, hearing, facial, bone and joint abnormalities. We describe the clinical presentation and surgical repair technique that included lensectomy, vitrectomy, peeling of vitreoretinal proliferative membranes, giant retinal tear management and prolonged use of intraocular silicone oil. Long-term clinical follow-up was observed. We highlight this case report as a therapeutic challenge in a deaf and high myopic child, with motor disabilities and atypical vitreoretinal disorders that have generated technical difficulties in surgical resolution. There is also little scientific references in the literature. This disease represents a clinical model of abnormal vitreoretinal interaction. RESUMEN Presentamos el manejo de un desprendimiento de retina regmatógeno no traumático en paciente pediátrico, en el contexto de un síndrome genético asociado a falla de síntesis de colágeno tipo 2 que se manifiesta en alteraciones oculares, auditivas, faciales y osteoarticulares. Se describe presentación clínica del cuadro y técnica de reparación quirúrgica que consistió en lensectomía - vitrectomía - pelaje de membranas de proliferación vitreorretinal - manejo de desgarro retinal gigante - retinopexia y tamponamiento prolongado con aceite de silicona. Se efectuó seguimiento clínico a largo plazo. Destacamos este caso por ser un desafío terapéutico en un niño sordomudo, alto miope, con discapacidad motora y que posee alteraciones vitreorretinales atípicas que generan dificultades técnicas en su resolución quirúrgica, existir una escasa literatura mundial de referencia y representar un modelo clínico de interacción vitreorretinal anómala.

Purpose: To evaluate the quality of life and vision in patients with keratoconus who underwent corneal collagen crosslinking (CXL). Methods: Cross-sectional study performed at a private ophthalmic clinic in the countryside of Rio Grande do Sul. 70 keratoconus patients who underwent CXL were interviewed. To evaluate the quality of life, the instrument Visual Function Questionnaire (VFQ) 25 was used. Results: The averages were high in the following subdomains: color vision, social aspects, dependency, peripheral vision, activities of daily living, near tasks, far tasks, mental health, ability to drive a car, vision and mental health. However, the dimensions of the ocular pain and general health presented low averages in relation to the others. Conclusion: Patients with keratoconus who underwent CXL presented high scores on ten of the twelve evaluated subdomains, which features good visual quality of life. Descriptors: Quality of Life; Keratoconus; Ophthalmology; Nursing; Questionnaire. RESUMO Objetivo: Avallar a qualidade de vida (QV) e de visào dos portadores de ceratocone submetidos ao crosslinking do colágeno corneano (CXL). Métodos: Estudo transversal, realizado em uma clínica oftálmica privada no interior do Rio Grande do Sul. Foram entrevistados 70 portadores de ceratocone submetidos ao CXL. Para avaliar a qualidade de vida foi utilizado o instrumento Visual Function Questionnaire (VFQ) 25. Resultados: As médias mostraram-se altas nos subdomínios: visào de cores, aspectos sociais, dependencia, visào periférica, atividades de vida diària, atividades para perto, atividades para longe, saúde mental, capacidade para dirigir automóveis, visào e saúde geral. Entretanto, as dimensóes da dor ocular e da saúde geral apresentaram médias baixas em relagào às demais. Conclusào: Os portadores de ceratocone subme-tidos ao CXL apresentaram escores altos em dez dos doze subdomínios avaliados, o que caracteriza boa QV visual. Descritores: Qualidade de Vida; Ceratocone; Oftalmologia; Enfermagem; Questionàrio.

Purpose: To review the outcomes, risk factors and morbidity of bacterial keratitis treated with and without topical steroids. Design: Retrospective cohort study. Methods: Demographics, risk factors, culture results, ulcer characteristics, and timing to epithe-lialization, visual acuity and recurrences were recorded. Patients were classified into 2 groups: 1. Topical antibiotics/steroids (ASG), and 2. Antibiotics only group (AOG). Results: Seventy-two eyes were identified. Thirty-seven were classified in the ASG and 35 in the AOG. Predisposing factors were identified in 87.5% of cases. Penetrating keratoplasty, previous surgery, contact lens wear and Herpes simplex keratitis were the most common overall. Microorganisms were identified in 85.5% and 60% of ASG and AOG, respectively. Epithelialization was completed at a mean 17.62 and 16.06 days in ASG and AOG, respectively (p= 0.533). Final mean BSCVA was 1.59±1.07 and 1.64±1.21 log MAR in ASG and AOG, respectively (p= 0.864). The number of gained Snellen lines was 0.13±0.22 in ASG and 0.14±.0.24 in AOG (p= 0.860). There were no recurrences. Conclusion: Although a non-statistical significant delay in re-epithelialization was noted in the ASG, this did not translate into a statistical difference in final BSCVA, gained Snellen lines or recurrence of infection. In this serie, adjuvant topical steroids were not associated with an increase in unfavorable outcomes. Resumen Objetivo: Analizar la morbilidad, factores de riesgo y resultados asociados al tratamiento de queratitis bacteriana con y sin el uso de esteroides tópicos. Diseño: Estudio de cohortes retrospectivo. Métodos: Se analizaron los datos demográficos, factores de riesgo, características de la úlcera, tiempo de re-epitelización, agudeza visual y recurrencias en pacientes con queratitis bacteriana. Los pacientes fueron clasificados en dos grupos: 1. Antibióticos/esteroi-des tópicos (ASG) y 2. Únicamente antibióticos (AOG). Resultados: Se identificaron 72 ojos, de los cuales 37 fueron clasificados en el ASG y 35 en el AOG. Encontramos por lo menos un factor de riesgo en el 87.5% de los casos; siendo los más comunes la queratoplastia penetrante, cirugía ocular previa, uso de lente de contacto y queratitis por Herpes simplex. Los cultivos lograron identificar un agente causal en el 85.5% y en el 60% del ASG y AOG, respectivamente. El epitelio cerró por completo en un promedio de 17.62 y 16.06 días en el ASG y AOG, respectivamente (p= 0.533). En promedio, la agudeza visual corregida al fin del estudio fue de 1.59±1.07 y 1.64±1.21 log-MAR en el ASG y AOG, respectivamente (p= 0.864). En promedio el ASG gano, 0.13±0.22 líneas en la cartilla de Snellen, mientras que el AOG ganó 0.14±.0.24 (p= 0.860). No hubo casos recurrentes. Conclusión: Aunque la re-epitelizacion fue un poco más lenta en el ASG, la diferencia no fue estadísticamente significativa ni se tradujo en cambios significativos en la agudeza visual corregida, el número de líneas ganadas en la cartilla de Snellen o el número de recurrencias. En esta serie, adyuvante encontramos que el uso adyuvante de esteroides tópicos no fue asociado con resultados desfavorables.

Endophthalmitis is a potentially vision-threatening complication associated with nearly every intraocular or periocular procedure, including cataract surgery and intravitreal injection. Post-operative endophthalmitis after cataract surgery is a familiar entity with well-established features and treatment. However, infectious endophthalmitis after intravi-treal injection is not as well understood. The current widespread use of intravitreal injections of vascular endothelial growth factor (VEGF) antagonists has raised increasing concern for post-injection endo-phthalmitis. Endophthalmitis associated with intravi-treal injections occurs with a similar low incidence as endophthalmitis associated with cataract surgery. Post-surgical and post-injection endophthalmitis exhibit similar clinical features, though post-injection endophthalmitis might present earlier. These entities share the most common causative organism, Sta-phylococcus epidermidis, although there is a higher incidence of more virulent and resistant organisms such as streptococcal species in post-injection en-dophthalmitis. The proportion of eyes with a culture-negative endophthalmitis has been found more commonly after intravitreal injection, raising concerns for distinguishing infectious endophthalmitis from sterile endophthalmitis, which may be associated with anti-VEGF therapy. The Endophthalmitis Vitrec-tomy Study (EVS) guides the treatment of exogenous endophthalmitis after cataract extraction. after cataract extraction, while the treatment of post-injection endophthalmitis is an area of new interest with emerging literature to guide management.

We describe herein a case of a 25 year-old female with main complain visual acuity loss in his left eye (OS) associated to a choroidal melanoma. Treatment with plaque brachytherapy using I125 was started. It was observed improvement regarding tumor size and best-corrected visual acuity (BCVA). However, at 39 months of follow up on brachytherapy, fundoscopic signs of radiation-induced retinopathy (microaneu-rysms, retinal hemorrhages, hard exudates, and neovascularization) were observed. Fluorescein angiography confirmed the diagnosis of radiation-induced retinopathy, with large areas of ischemia and neovascularization. Focal argon photocoagulation was used as treatment with excellent results in 5 years follow-up.

The rare, non-caseating, granulomatous disease known as Melkersson-Rosenthal syndrome (MRS) can be diagnostically difficult especially when not presenting as the characteristic triad of facial palsy, facial edema, and fissured tongue.¹ We present a case of a 65-year-old female with a 15-year history of recurrent bilateral upper eyelid swelling previously unsuccessfully treated for a presumed lid allergy and rosacea. Following imaging and histopathology results, she has now been diagnosed with Melkersson-Rosenthal syndrome. Since this disease is typically refractory to treatment, she is being followed and treated with cosmetic eyelid skin reduction if necessary during inactive stages of the disease.

Purpose: To compare the results of the coaxial ml-crolnclslons cataract surgery technique and bimanual mlcrolnclslons in the Cuban Ophthalmology Institute “Ramón Pando Ferrer” from June 2009 to June 2011. Methods: Sixty-eight patients were evaluated and diagnosed with senile or presenile cataract. Of these, 41 patients (eyes) were operated with coaxial mlcroln-clslons technique and 27 patients (eyes) with blma-nual mlcrolnclslons technique. We determined age, hardness of the nucleus, best corrected visual acuity and uncorrected preoperative and postoperative, mean induced astigmatism, endothelial cell loss, effective phaco time and spherical equivalent. For statistical analysis, the nonparametrlc Mann Whitney test with a significance of 95% was used. Results: Most patients were older than 50 years. An ultrasound effective time of less than a minute was required to emulsify the cataractous lens, which had hardness classified as NO3 by the LOCS III for both techniques. The spherical equivalent behaved as preo-peratlvely planned with a tendency to emmetropia. A significant correction of the keratometrlc and refractive cylinder was obtained. Fully corrected visual acuity was achieved with both techniques. The mean induced as-tlgmatlsm was less than 0.5 diopters, with endothelial cell loss of less than 5% in both groups. Conclusions: Both surgical techniques achieved satisfactory results demonstrating their effectiveness. RESUMEN Objetivo: Comparar los resultados de la cirugía de catarata por las técnicas de microincisiones coaxiales y microincisiones bimanuales en el Instituto Cubano de Oftalmología “Ramón Pando Ferrer” en el período de junio de 2009 a junio de 2011. Métodos: 68 pacientes fueron evaluados y diagnosticados con catarata senil o presenil. De estos, 41 pacientes (ojos) se operaron con la técnica de microincisiones coaxiales y 27 pacientes (ojos) con la técnica de microincisiones bimanuales. Se determinó: edad, dureza del cristalino, agudeza visual mejor corregida y sin corrección preoperatoria y postoperatoria, media del astigmatismo inducido, pérdida celular endotelial, tiempo efectivo de ultrasonido y el equivalente esférico. Para el análisis estadístico, se utilizó el test no paramétrico U de Mann Whitney con una significación del 95%. Resultados: La mayoría de los pacientes tenían edades superiores a 50 años. Se empleó un tiempo efectivo de ultrasonido menor a un minuto para emulsificar los cristalinos cataratosos, los cuales tenían una dureza clasificada como NO3 por el LOCS III para ambas técnicas. El equivalente esférico se comportó según lo planificado en el preoperatorio con tendencia a la emetropía. En el postoperatorio se obtuvo una corrección significativa del cilindro queratométrico y refractivo. Para ambas técnicas quirúrgicas mejoró en su totalidad la agudeza visual con corrección alcanzando su valor máximo. La media del astigmatismo inducido fue menor a 0,5 dioptrías, con una pérdida celular endotelial menor a un 5% en ambos grupos. Conclusiones: Para ambas técnicas quirúrgicas se lograron resultados satisfactorios que demuestran la efectividad de las mismas.

Purpose: To assess the efficacy of one drop of 2% pilocarpine (2% Pi) at night to reverse the intraocular pressure (IOP) peak at 6:00 am in the daily curve of intraocular pressure (DCPo) of pre-perimetric open-angle glaucoma. Methods: We retrospectively analyzed the charts of patients with early glaucoma. We compared the IOP values at 6:00 a.m. in the same eye of two DCPos. In the first DCPo, the patients were without medication, and in the second they were using one drop of 2% Pi between 10:00 and 10:30 p.m. for at least six months. Each DCPo had five IOP measurements taken at 9:00 a.m., 12:00, 6:00 and 10:00 p.m. (Goldmann applana-tion tonometer) and in the morning of the following day at 06:00 a.m. (Perkins tonometer) in a supine position in bed and in darkness before the patient had stood up. The pre-perimetric glaucoma patients, without medication, presented an IOP peak at 6:00 a.m. in the DCPo. This peak represents a difference ≥7 mmHg between the IOP value at 6:00 a.m. and that lesser IOP at any other time in the DCPo. An IOP peak reversion at 6:00 a.m. under 2% Pi occurred when the difference between the IOP at 6:00 a.m. and the lesser IOP was ≤5 mmHg in the DCPo. Patients with secondary glaucoma were excluded. We set the significance level at 5% (P<0.05). Results: Sixty-one eyes of 35 patients with an average age of 56.1 years were included. Under 2% Pi the IOP peak at 6:00 a.m. reversed significantly (X²=7.96; P=0.005) in 44 (72.1%) eyes. The mean IOP dropped from 22.1±2.3 mmHg in the DCPo without medication to 16.8±2.7 mmHg in the DCPo under 2% Pi (t=7.9; P<0.001). Conclusion: One drop of 2% Pi at night is effective to reverse the IOP peak at 6:00 a.m. in pre-peri-metric glaucoma.

The induction of corneal collagen cross-linking by ultraviolet radiation (UV) over a substract of riboflavin was popularized and dubbed as CXL (cross-linking). In 2003, this technique was introduced in the therapeutic arsenal for patients with keratoconus, aiming to halt the progression of the disease. The procedure would enhance biomechanical and biochemical corneal stability by the formation of new covalents bonds in the amino-termial sites of the collagen molecule of the anterior stroma. Such induction depended on the hydrogen singlets free radicals generated by the riboflavin photosensibilization by UV-A. CXL is indicated in corneal thinning and progressive ectasias, as it happens in keratoconus, post-LASIK ectasia and pellucid marginal degeneration. Other anecdotic indications are described in the literature such as treatment of infectious keratitis, control of bullous keratopathy and corneal melting; however, they will not be discussed in this review. The CXL for the treatment of progressive corneal ectasia is a procedure that does not involve sophisticated equipments. It is safe (low odds of complications), not expensive and with high efficacy (halting the progression of ectasia). The great majority of treated patients are young adults. There are some contraindications for this procedure such as minimum corneal thickness of 400 ìçé, which is the most feared. The classic technique was described in 1995 by German researchers and variations of this technique still under evaluation. The CXL is a recent procedure and, besides some favorable results, a long-term follow up (more than 5 years) is needed, to evaluate collateral side effects and potential complications. RESUMO A inducao de novas ligações covalentes entre cadeias de colágeno da córnea pela radiação ultravioleta (UV), tendo como substrato a riboflavina, foi popularizada com a sigla CXL (cross-linking). Em 2003, foi introduzida no arsenal terapêutico de pacientes com ceratocone, com o objetivo de evitar a progressão da doença. O procedimento aumentaria a estabilidade biomecânica e bioquímica da córnea pela formação de novas ligações covalentes entre as porções amino-terminais das moléculas do colágeno no estroma anterior. Tal indução se dá às custas dos radicais livres dos hidrogênio singlets gerados na fotossensibilização da riboflavina pela luz UV-A. O CXL é indicado, em geral, nos afinamentos e ectasias da córnea de caráter progressivo, como acontece no ceratocone, na ectasia pós-LASIK e na degeneração marginal pelúcida. Outras indicações anedóticas são descritas na literatura como, por exemplo, para o tratamento de algumas ceratites infecciosas, para controle da ceratopatia bolhosa e necrólise da córnea; porém, não serão abordadas nesta revisão. O CXL para o tratamento da ectasia progressiva é um procedimento que não envolve equipamentos sofisticados, seguro (com baixas chances de complicações), de baixo custo e alta eficácia (parada da progressão da ectasia). A maioria dos pacientes submetidos tratados é de adultos jovens. Há contraindicações para o procedimento e, dentre estas, a espessura mínima de 400 μm é a mais respeitada. A técnica mais utilizada e considerada como clássica é a descrita em 1995, por pesquisadores alemães. Variações da técnica clássica estão ainda em avaliação. O CXL é um procedimento recente e apesar dos resultados até agora serem favoráveis, acompanhamento a longo prazo (mais de 5 anos) é necessário, inclusive em relação aos efeitos colaterais e potenciais complicações.