An 8-year-old girl, who underwent pars plana lensectomy and vitrectomy for non-infectious uveitis, was treated with a dexamethasone intravitreal implant (Ozurdex^®, Allergan Inc., Irvine CA), because of the persistence of cystoid macular edema. The implant migrated into the anterior chamber; however, no cornea edema was detected and a complete resolution of macular edema was observed.

El síndrome de isquemia ocular es una patología rara, secundaria a hipoperfusión debido a estenosis o oclusión de las arterias carótidas común o interna. Varón, de 78 años, que acudió por disminución de agudeza visual progresiva, de meses de evolución, en su ojo derecho (OD). La Mejor Agudeza Visual Corregida (MAVC) en su OD era de no percepción de luz. La exploración biomicroscópica del polo anterior en OD reveló la presencia de microhipema y neovascularización iridiana en los 360º. La presión intraocular era normal. Mediante la exploración funduscópica y la angiografía fluoresceínica, se confirmó la presencia de signos de isquemia retiniana y coroidea, todo ello compatible con un posible síndrome de isquemia ocular. Se realizó panretinofotocoagulación, y se solicitó Eco-Doppler de Troncos Supraaórticos y angio-TC que confirmaron la presencia de una obstrucción completa en la arteria carótida interna derecha, no susceptible de tratamiento quirúrgico. A los 7 meses, el paciente permanece estable clínicamente, desde el punto de vista ocular y sistémico. En estos casos, es de gran trascendencia la evaluación sistémica del paciente, incluyendo realización de Eco-Doppler de TSA o angio-TC, y el abordaje multidisciplinar, pues un adecuado y precoz diagnóstico puede condicionar no solo el pronóstico visual, infausto en nuestro caso, sino también la supervivencia del paciente. Palabras clave: obstrucción carotídea, isquemia ocular, glaucoma, neovascularización, agudeza visual. Abstract Ocular ischemic syndrome is a rare condition, secondary to hypoperfusion due to stenosis or occlusion of the common or internal carotid artery. A 78 year-old male, who complained of progressive acuity visual loss, in his right eye (RE). His Best Corrected Visual Acuity (BCVA) in RE was No light perception. Biomicroscopic exploration of anterior segment revealed the presence of microhyphema and iris neovascularization in 360 degrees. Intraocular pressure was normal. Fundoscopy and fluorescein angiography confirmed the presence of retinal and choroidal ischemia, compatible with an ocular ischemic syndrome. Panretinophotocoagulation was performed, and Eco-Doppler of supraaortic trunks (SAT) and angio-CT were requested, and they confirmed the presence of complete obstruction of right internal carotid artery, surgically untreatable. Seven months ago, the patient remains clinically stable, with no ocular nor systemic changes. In these cases, systemic evaluation of the patients, including performance of Eco-Doppler of SAT or angio-CT, and the multidisciplinary approach, is crucial, as a prompt and adequate diagnosis can influence visual prognosis, awful in our case, and patient survival.

A 45-year-old man submitted to radial keratotomy 19 years ago acquired Cladosporium sp. infection in one of the incisions of the left eye. The infection was resistant to topical amphotericin B, topical natamycin and systemic fluconazole. The keratitis was cured with voriconazole 200 mg PO, BID for 10 days.

Resumen Objetivo: Determinar las modificaciones de la curvatura posterior de la córnea en pacientes a los que se realizó queratomileusis subepitelial asistida por laser miópico en el período de abril a noviembre 2011. Método: Fueron estudiados 15 pacientes (29 ojos), a los que se realizó queratomileusis subepitelial asistida por laser miópico. Se analizaron variables como edad, sexo, equivalente esférico, paquimetría preoperatoria, cantidad de ablación, estroma residual y diferencia de elevación posterior corneal, esta última obtenida del mapa de diferencia del tomógrafo Pentacam HR con medición preoperatoria, al mes y tres meses de la cirugía. Se realizó análisis de regresión múltiple. Resultados: El equivalente esferico, la paquimetria, cantidad de ablacion y el estroma residual se encontraron dentro de los parametros de seguridad establecidos. La diferencia promedio de la elevacion posterior corneal fue de 3,3 μm al mes, disminuyendo a 2,4 μm a los tres meses. Se observo relacion con la cantidad de ablacion y el estroma residual. Conclusiones: La queratomileusis subepitelial asistida por laser determinó modificaciones en la superficie corneal posterior, las cuales fueron más evidentes en el primer mes del posoperatorio. El estroma residual fue el factor más relacionado con estas modificaciones. Palabras clave: LASEK, elevación corneal posterior, paquimetría, estroma residual, total de ablación. Abstract Purpose: To determine the posterior corneal surface forward shift in myopic patients after laser-assisted subepithelial keratectomy from April to November 2011. Material and methods: Fifteen patients (29 eyes) were submitted to laserassisted subepithelial keratectomy surgery. Age, sex, spherical equivalent, preoperative corneal thickness, total ablation, residual bed thickness and variations in the posterior corneal surface elevation were evaluated. Posterior corneal surface elevation maps were assessed by Pentacam HR tomography and compared with the data of maps obtained prior to the surgery, one and 3 months after the procedure. Results: The spherical equivalent, pachymetry, microns of ablation and residual bed thickness were within the established parameters. The posterior corneal surface displayed a forward shift of 3,3 μm after a month and 2,4 μm three months later. A relation was found between total ablation, and residual bed thickness. Stepwise lineal multiple regression was used. Conclusions: The use of the laserassisted subepithelial keratectomy determined a forward shift of the posterior corneal surface in the early postoperative that gradually decreased. Residual bed thickness was a relevant factor associated to this change.

Purpose: To assess the visual outcome and refractive error following wavefront (WF)-optimized laser in situ keratomileusis (LASIK) retreatment after previous WF-guided LASIK in myopic patients. Methods: A retrospective analysis of 19 eyes (14 patients) following WF-optimized LASIK retreatment after previous WF-guided LASIK that did not give desired refractive results was conducted. The primary LASIK procedures were performed using the Visx CustomVue™ laser with WF-guided technology. All of the subsequent retreatment LASIK procedures were performed with the Wavelight Allegretto™ Eye-Q 400 excimer laser using WF-optimized. Ophthalmic evaluations including uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were performed at baseline and postoperatively at 1, 3, 6 months. Results: UCVA and BSCVA improved following retreatment from 0.27±0.18 and 0.0±0.05 to 0.01±0.05 and -0.03±0.05 respectively at 6 months (p<0.001 and p=0.38). The MRSE decreased from -0.5 D pre-retreatment to -0.2 D at 6 months postretreatment. The pre-retreatment total HOA was 0.48±0.21 (0.24 to 1.01μm) and did not show correlation with the visual outcomes postoperatively. No intra-operative or postoperative complications occurred. Conclusions: The results of this small case series with patients presenting low degrees of residual ametropia indicate that WF-optimized LASIK retreatment could be considered as an option after primary WFguided LASIK. Retreatment with WF-optimized LASIK is safe and the results are predictable.

Age-related macular degeneration (AMD) is a chronic disease affecting the retina and is the most common cause of blindness in the ageing population in the developed world. Correct and timely diagnosis and classification allows physicians to estimate which patients are at high risk of progressing to more advanced stages of the disease In February 2012, 23 Latin American experts met in Cartagena, Colombia, to develop a Consensus on AMD. This paper summarizes the main points of the discussions including definitions, diagnosis, antiangiogenic treatments, and hopes for the future. Dry AMD remains untreatable but results from promising Phase II trials are awaited eagerly. Antiangiogenics, such as the licensed vascular endothelial growth factor (VEGF) inhibitors, aflibercept and ranibizumab, have revolutionized the treatment of wet AMD in recent years. These drugs work by inhibiting the choroidal neovascularization that causes the rapid vision loss in wet AMD. Another antiangiogenic, bevacizumab, is also commonly used off-label, but is not approved currently for intraocular use. However, barriers to treatment compliance, due to the frequency of monthly injections, can also affect the efficacy of these antiangiogenic therapies. Aflibercept has a longer duration of action compared with other treatments and thereby offers reduced injection frequency. By relieving patients of the need for monthly visits, it can help reduce the growing burden of AMD patients on healthcare resources.