Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. / Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica.

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

Phakic intraocular lenses: Recent advances and innovations. / Lentes intraoculares fáquicas: recientes avances e innovaciones.

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Equatorial wrinkles in the human lens capsule.

Equatorial wrinkles, or crenations, have been previously observed around the equator in coronal images of the human ocular lens. However, wrinkles are typically not apparent when the lens is viewed from saggital directions. In the current paper, the existence and geometry of these wrinkles is shown to be consistent with a mechanical model of the isolated lens, in which the capsule is held in a state of residual tension by a spatially uniform internal pressure. The occurrence of equatorial wrinkles is therefore seen to be a mechanical consequence of the spheroidal shape of the lens capsule and an excess intralenticular pressure. New observations are made, on post mortem lenses, on the geometric arrangement of these equatorial wrinkles. These observations indicate a well-defined pattern in which wrinkles exists along meridional lines in the equatorial regions of the lens. A preliminary 'puncture test' is used to demonstrate that the residual stresses within the capsule in the equatorial region of the lens are broadly consistent with the proposed mechanical model of the lens capsule. It is suggested that the presence of equatorial wrinkles may have an influence on the mechanical performance of the capsule during the accommodation process.

Treatment resistant fungal keratitis caused by Colletotrichum gloeosporioides.

CASE REPORT: A 56 year old woman suffered corneal injury from a branch of an orange tree. Forty days later she suffered a severe ocular infection, positive to Colletotrichum gloeosporioides (C. gloeosporioides). The patient did not respond to traditional treatment or crosslinking, and had to be treated with keratoplasty, suffering intraoperative and postoperative complications. DISCUSSION: Ocular infections due to C. gloeosporioides can occasionally be refractory to traditional and new treatments, such as crosslinking.

Post-surgical visual outcome and complications in Boston type 1 keratoprosthesis.

OBJECTIVE: To describe the visual outcome of patients who underwent Boston type 1 keratoprosthesis (KPro1) implantation, and describe serious sight-threatening post-operative complications. METHODS: We performed an analysis of the clinical records of all patients who underwent Boston keratoprosthesis implantation (BKI)in our institution from May 2006 to February 2011. RESULTS: A total of 41 eyes of 37 patients were included in the final analysis, of whom 22 (59.45%) were male and 15 were (40.54%) female. The mean age was 56.44 years (range 2-90). The most frequent diagnoses were bullous keratopathy, autoimmune diseases, such as Stevens-Johnson syndrome (SJS)/Lyell syndrome (LS), and aniridic keratopathy. The mean number of previous keratoplasties (PK) was 2.36 (range 0-8), the mean number of previous non-PK surgeries was 1.58 (range 0-9). The mean follow-up time was 22.17 months (range 3-46). The mean best corrected visual acuity (BCVA) logMAR before surgery was 2.05 (range 1.10-2.52), and the mean best corrected visual acuity achieved after surgery was 1.16 (range 0.08- 2.70). The most frequent complication was the formation of retroprosthetic membrane (RPM) which appeared in 22 (53.65%) eyes. Of these, 6 (27.27%) appeared after another surgery. Fourteen (63.63%) RPM required treatment, an average of 1.71 (range 1-4) laser YAG applications were performed, and surgical membranectomy was performed in 3 patients. Eleven (26.82%) eyes showed chorioretinal adhesion problems, 6 (14.63%) of which occurred after follow-up of BKI surgery. Infectious complications occurred in 7 (17.07%) cases; 2 (4.87%) patients had infectious keratitis and 5 (12.19%) endophthalmitis. CONCLUSIONS: Visual function improved in most patients. Those with prior multiple ocular surgeries and alterations of systemic immunity such as SJS, LS, and diabetes mellitus are at increased risk for serious sight-threatening complications, such as RPM, chorioretinal detachment and infection. Nevertheless, we consider KPro as an effective alternative in patients with multiple ocular pathology and imminent risk of rejection of a new KP.

[Interferon alpha 2ß, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma]. / Interferón alfa 2-ß, queratectomía parcial y trasplante de membrana amniótica para el tratamiento de un carcinoma escamoso conjuntival recidivante.

CASE REPORT: An 80-year-old woman diagnosed with a recurrent squamous conjuctival carcinoma treated with surgical excision of the lesion, zonal reconstruction and topical Interferon alpha 2-ß. DISCUSSION: Squamous conjunctival carcinoma is the most frequent neoplasm of the ocular surface. Surgical removal of the lesion is the traditional treatment, but this technique has a high recurrence rate. Interferons are glycoproteins that trigger intracellular pathways with antiviral and antitumoral properties. Recent studies have proven their activity against conjunctival carcinoma.

Interferón alfa 2-b, queratectomía parcial y trasplante de membrana amniótica para el tratamiento de un carcinoma escamoso conjuntival recidivante / Interferon alpha 2b, partial keratectomy and amniotic membrane transplant for the treatment of a recurrent conjunctival squamous carcinoma

Caso clínico: Mujer de 80 años de edad diagnosticada de carcinoma escamoso conjuntival recidivante tratado con escisión quirúrgica de la lesión, reconstrucción zonal e interferónalfa 2-b tópico. Discusión: La neoplasia escamosa de la conjuntiva y córnea es el tumor más frecuente dela superficie ocular. La cirugía mediante resección de la lesión es el método tradicional de tratamiento de estos tumores, pero presenta un elevado índice de recurrencias. La inmunoterapia es una alternativa actual para estos tumores. Los interferones son glicoproteínasque actúan activando una cascada de eventos intracelulares que confieren una actividad antivirales y antitumoral. Su actividad frente a las neoplasias epiteliales de la superficieocular se ha demostrado en los últimos años(AU)

Case report: An 80-year-old woman diagnosed with a recurrent squamous conjuctival carcinoma treated with surgical excision of the lesion, zonal reconstruction and topical Interferonalpha 2-b. Discussion: Squamous conjunctival carcinoma is the most frequent neoplasm of the ocularsurface. Surgical removal of the lesion is the traditional treatment, but this technique has a high recurrence rate. Interferons are glycoproteins that trigger intracellular path ways with antiviral and antitumoral properties. Recent studies have proven their activity againstconjunctival carcinoma(AU)

Adenoma of the nonpigmented ciliary epithelium.

PURPOSE: To report the clinicopathologic features of an adenoma of the nonpigmented ciliary epithelium. DESIGN: Single interventional case report. METHODS. A nonpigmented iris and ciliary body tumor was diagnosed in a 66-year-old woman who complained of blurred vision related to a unilateral cataract. A combined cataract surgery and partial lamellar sclerouvectomy was performed. RESULTS: Histopathologic findings disclosed an adenoma of the nonpigmented ciliary epithelium. CONCLUSIONS: Unilateral cataract in an adult patient can be rarely related to a tumor growing from the ciliary epithelium. Adenoma of the non pigmented ciliary epithelium may mimic an amelanotic melanoma. Partial lamellar sclerouvectomy is an effective method to manage this condition and to confirm the diagnosis.

Fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution for inflammation after cataract surgery: a randomized, comparative, active treatment-controlled trial.

PURPOSE: To assess the efficacy, tolerance, and ocular tolerability of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution compared with 0.1% diclofenac (Voltaren) and 0.3% tobramycin (Tobrex) in patients undergoing cataract extraction by either nuclear expression (extracapsular) or ultrasound-assisted aspiration (phacoemulsification) with intraocular lens implantation. METHODS: Eighty-eight patients undergoing cataract extraction with intraocular lens implantation participated in a randomized, parallel, observer-masked trial, in which the clinical usefulness of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution, two eyedrops every 6 hours (n = 44) was compared with Voltaren and Tobrex, one drop of each every 6 hours (n = 44) in a 22-day course. Efficacy was assessed from changes of the sum of anterior chamber cell count plus flare, conjunctival hyperemia and edema, and ciliary congestion, by means of slit lamp biomicroscopy on days 1, 7, 14, and 21. Tolerance and ocular tolerability were assessed by recording intraocular pressure (IOP), side effects, and the patient's and investigator's opinions. RESULTS: Anterior chamber cell count plus flare showed no differences in the two treatment groups at any evaluation point. The study treatment was associated with a significantly higher score for conjunctival edema on day 1 (p = 0.015), conjuncitval hyperemia on day 14 (p = 0.009) and anterior chamber cell count on day 21 (p = 0.04), but these differences had no clinical relevance. No side effects related to the study treatment were recorded. CONCLUSIONS: Efficacy, tolerance, and ocular tolerability of a fixed-dose combination of 0.1% diclofenac plus 0.3% tobramycin ophthalmic solution were comparable to Voltaren plus Tobrex for the control of anterior chamber inflammation after cataract surgery, with the advantage that both active principles are supplied in a single container.

Storage, surgery, outcome, complications, and new developments in corneal and conjunctival grafts.

This review covers last year's literature on corneal, limbal, and conjunctival transplantation including tissue storage and eye banking. In this area, the main themes were related to a better evaluation of tissue viability and the exclusion of disease transmission. An analysis of the changing indications for penetrating keratoplasty shows the differences between American and European series. Most efforts in relation to surgical techniques are oriented toward obtaining better refractive results, whereas the study of large series sheds new light on the risk factors for graft failure and other complications. Limbal transplants have acquired the status of a new field in the surgical treatment of ocular surface disease, particularly in relation to corneal stem cell deficiencies.

[Angiogenesis factor in intraocular tumors]. / El factor angiogenético en los tumores intraoculares.

The method of the angiogenic response of the chick embryo chorioallantoic membrane is applied to study the tumor angiogenic factor, that was present in the aqueous humor but not in the vitreous humor of patients with choroidal melanoma or retinoblastoma.