Resumen La queratopatía cristalina es una infección corneal de evolución crónica en la que podemos encontrar un infiltrado estromal blanco arboriforme asociado a una mínima reacción inflamatoria. La mayoría de los casos ocurren en córneas transplantadas en tratamiento con corticoides tópicos. Mujer de 91 años con antecedentes de perforación ocular tratada mediante queratoplastia penetrante excéntrica. Un año después presentó una agudeza visual de percepción de luz, gran reacción inflamatoria y un infiltrado corneal blanquecino de aspecto arboriforme. Se inició tratamiento con vancomicina intravenosa y vancomicina y amikacina intravítreas, tópicas e intracamerulares y se obtuvieron muestras de humor acuoso y del infiltrado corneal mediante arrastre con aguja de safil de 8/0 con resultado microbiológico positivo para Candida Parapsilosis. Se inició entonces tratamiento con voriconazol y trimetroprimsulfametoxazol tópicos con respuesta favorable. En la queratopatía cristalina, la reacción inflamatoria inducida en el huésped suele ser leve debida, en parte, a la escasa replicación de los microorganismos implicados. El caso que presentamos es atípico puesto que encontramos una intensa reacción inflamatoria; sin embargo tanto el aspecto biomicroscópico de la córnea, como el resultado del análisis microbiológico y la respuesta positiva al tratamiento, apoyan el diagnóstico de queratopatía cristalina por Candida Parapsilosis. Palabras clave: queratopatía, cristalina, infección, corneal,cándida Crystalline keratopathy is a corneal infection with chronic evolution in which we can find white branching aggregates in corneal stroma in absence of host inflammatory response. It most frequently occurs in corneal grafts with chronic topic corticosteroid treatment. 91-years-old woman with tectonic keratoplasty because of ocular perforation who presented one year later of surgery a best corrected visual acuity of light perception with intense inflammatory response and white branching aggregates in corneal stroma. Treatment with intravenous vancomycin and topic, intravitreal and intracameral vancomycin and amikacin was started. Aqueous humor and corneal infiltrate samples were obtained. The second one was acquired by dragging using a safil 8/0 needle. Microbiological study showed an infection by candida parapsilosis, so treatment with topic voriconazol and trimethoprim sulfamethoxazole was started with good clinical evolution. Crystalline keratopathy usually associates a small host inflammatory response, in part due to the poor replication of involved microorganisms. The case presented previously is an atypical one because of the intense inflammatory response, however, clinical appearance, microbiological results and treatment response are typical of crystalline keratopathy.

We report a case of adult-onset foveomacular vitelliform dystrophy complicated with atrophic involution and subsequent choroidal neovascularization and treated with intravitreal ranibizumab. A 71-year-old woman diagnosed with adult-onset foveomacular vitelliform dystrophy experienced a progression of the vitelliform lesion to the atrophic stage in her left eye immediately after cataract surgery. Best-corrected visual acuity decreased from 0.5 to 0.16. Ten months later, the patient was referred with new worsening of her visual acuity (0.05) and metamorphopsia. The spectral-domain optical coherence tomography confirmed the presence of type 2 choroidal neovascularization next to the atrophic area. The patient was treated with 2 monthly injections of ranibizumab. Spectral-domain optical coherence tomography images improved significantly and her best-corrected visual acuity increased to 0.20 associated with subjective improvement of metamorphopsia. Ranibizumab may be effective for choroidal neovascularization in patients with adult-onset foveomacular vitelliform dystrophy.

A 27-year-old woman with bilateral high myopia had anterior chamber iris-claw phakic intraocular lens implantation in her left eye under local anesthesia and with no intraoperative complications. The preoperative slit-lamp examination was normal, and she had no relevant past medical history. On the second postoperative day, patient developed fixed, dilated mydriasis, and one month later, an IOL subluxation was noted on examination. She had no history of intraocular hypertension and no mydriatic drops were used. She was ultimately diagnosed with Urrets-Zavalia syndrome. We removed the IOL and observed the patient for six months after fitting her with a colored contact lens. During this period of time, she complained of glare and photophobia and developed contact lens intolerance. To bring more comfort to the patient, we implanted a posterior chamber Implantable Collamer Lens (ICL) and performed iris cerclage in the left eye with good aesthetic and refractive outcome. Posterior chamber ICL implantation with iris cerclage proved to be a simple and effective approach in the management of this situation.

Purpose: To present six cases of macular suberetinal hemorrhage who underwent intravitreal treatment with rtPA, ranibizumab and SF₆. Methods: Size and location of the hemorrhage and visual acuity were evaluated prior and after treatment. Results: Mean pretreatment visual acuity was hand movements at one meter, and three months later, 0.18 (decimal notation) (p>0.05). A partial displacement of de suberetinal hemorrhage from the fovea was achieved in all patients. Discussion: This triple procedure is an useful option for the treatment of suberetinal hemorrhage. However, the tissular damage associated to the subjacent disease in some cases does not allow significant functional improvement.

Purpose: To analyze the prevalence and morphometric characteristics of macular hole development in patients with neovascular age-related macular degeneration treated with ranibizumab. Methods: Patients diagnosed of neovascular age-related macular degeneration from January 2009 to December 2010 have been analyzed. Measurement of visual acuity and optical coherence tomography were scheduled. Results: Two hundred and thirteen eyes (patients) with exudative age-related macular degeneration were analyzed. Development of macular hole was evidenced in 4 eyes (1,9%) Discussion: Macular hole formation is a severe complication in patients with choroidal neovascularization treated with ranibizumab, frequently undervalued, which interferes with final outcome.

This article reviews the Bayesian statistical approach to diagnostic test analysis and application in the management of glaucoma patients. The central idea of the Bayesian method is the use of study data to update the state of knowledge about a quantity of interest. In diagnostic test analysis, the Bayesian approach explicitly elicits a clear interpretation of chances of a particular eye disease given a positive test result. The Bayesian method also provides a reasonable rationale for deciding whether to perform a laser iridotomy in a patient with occludable angles. We present several literature examples of Bayesian methods in practice, especially as it relates to glaucoma evaluation and progression.