RESUMEN Objetivo: Reportar el caso de un paciente con queratocono unilateral verdadero en el ojo derecho asociado a fibrosis localizada en la órbita ipsilateral. Métodos: Hombre de 25 años de edad con agudeza visual progresiva en el ojo derecho con diagnóstico de queratocono unilateral y fibrosis orbitaria unilateral. El ojo derecho con una agudeza visual de 20/800 que mejoraba a 20/40 con una refracción de -7.50 -6.00 x 175°, presentando signos clínicos de queratocono. Los movimientos oculares muestran limitaciones en la mirada hacia arriba en todas las posiciones. El ojo y órbita del lado izquierdo sin ninguna alteración con una agudeza visual de 20/20. Resultados: Se realizó tomografía computada, confirmando el diagnóstico de fibrosis orbitaria en la órbita derecha, las topografías corneales a través del tiempo mostraron progresión evidente del queratocono en el ojo derecho y estabilidad en el ojo izquierdo. Conclusiones: El queratocono unilateral verdadero es una condición rara. La asociación de queratocono unilateral con alteraciones unilaterales de párpados y órbita se ha descrito previamente. Sin embargo, según nuestro conocimiento, este es el primer reporte de fibrosis orbitaria asociado con queratocono. ABSTRACT Purpose: To report a case of a patient who presented with true unilateral keratoconus in his right eye associated to a localized fibrosis in his ipsilateral orbit. Methods: A 25-year old male with progressive visual acuity loss in the right eye was diagnosed with unilateral keratoconus and unilateral orbital fibrosis. Right eye visual acuity was 20/800 improving to 20/40 with a refraction of -7.50 -6.00 x 175° and he presented with clinical signs of keratoconus. Eye movements showed limitations in the upper gaze of the right eye in all positions. The fellow eye and orbit were under normal limits and visual acuity was 20/20. Results: Computed Tomography scan confirmed the diagnosis of orbital fibrosis in the right orbit and corneal topographies during a time span showed evident keratoconus progression of the right eye and stability in the left eye. Conclusions: True unilateral keratoconus is a rare condition. Association of unilateral keratoconus with unilateral eyelid and orbital conditions has been previously reported. Nevertheless, to our knowledge, this is the first report of orbital fibrosis associated with keratoconus.

Purpose: Report technique utilizing multilayered folded dehydrated amniotic membrane for refractory scleral delle management. Methods: A 3 x 2 centimeter dehydrated amniotic membrane was folded four times onto itself, with the basement membrane side on the exterior, to yield a 7.5 x 10 millimeter graft. This was sutured into the delle using four 9-0 vicryl sutures. Once adequate fixation of the multilayered folded graft was obtained, a primary conjunctival closure was performed using five 9-0 vicryl sutures. Total surgical time was fifteen minutes. Results: This technique was utilized on one patient with a refractory scleral delle after undergoing pterygium excision outside of my institution with bare sclera technique and intra-operative mitomycin C application. No post-operative complications or recurrence of the delle occurred after 9 months of followup. Conclusion: This technique provides an alternative efficient management of refractory scleral dellen while avoiding use of donor corneal or scleral tissue.

Acanthamoeba Keratitis. A Case Report Case report: A 33 year-old male, with hyperemic painful eye and no improvement after antibiotic and corticoid topic therapy. By biomicroscopy: annular infiltrate with inferior de-epithelialization, and limbal inflammation. Due to the suspicion of Acanthamoeba keratitis, we started treatment with clorhexidine 0.02%, polimyxin B+neomicin+ gramicidin (Oftalmowell^®) and propamidine isethionate (Brolene^®). A microbiological diagnosis confirmed the presence of Acanthamoebae, and diagnosis of Acanthamoeba keratitits was established. We observed a satisfactory evolution, with formation of a central corneal leukoma, followed by penetrating keratoplasty, with good results. Discussion: Clinical and microbiological early diagnoses are fundamental, since inappropirate treatment will lead to the development of cysts, and treatment resistance. Acanthamoeba keratitis, early diagnosis, microbiological diagnosis. Caso clínico: Varón de 33 años con ojo hiperémico, doloroso, sin mejoría tras tratamiento con antibióticos y corticoides tópicos. A la exploración biomicroscópica: infiltrado anular desepitelizado por la parte inferior, con limbitis. Ante la sospecha de queratitis por Acanthamoebae, se inició tratamiento con clorhexidina 0.02%, polimixina B+neomicina+gramicidina (Oftalmowell^®) e isetionato de propamidina (Brolene^®). El estudio microbiológico confirmó el crecimiento de Acanthamoebae, por lo que se estableció el diagnóstico de queratitis por Acanthamoeba. La evolución fue satisfactoria, con formación de leucoma corneal central, que llevó a queratoplastia penetrante, con buenos resultados. Discusión: Un diagnóstico precoz, clínico y microbiológico es fundamental, pues un tratamiento inicial poco acorde dará lugar al enquistamiento y resistencia al tratamiento. Palabras clave: Queratitis por Acanthamoeba, diagnóstico precoz, diagnóstico microbiológico.

Purpose: To described the incidence of retinal detachment (RD) in patients with preoperative high myopic value after five year of phakic intraocular lens (pIOL) was implant Artisan/Artiflex. Setting: Instituto de Ojos Oftalmosalud, Lima, Peru. Methods: This retrospective study included a review of 203 medical records (271 eyes) of patients with myopic refraction that underwent pIOL implantation by the same experimented surgeon between January 2004 to 2009, with a minimum postoperative follow-up of 1 year. The inclusion criteria were patients over 18 years old, a spherical equivalent (SE) over -6.00 Diopter (D) or with an axial length greater than 26mm, stable refraction for at least 2 years with best visual acuity (BVA) better than 20/100, without abnormalities in the anterior segment, and minimum endothelial cell count of 2,000 cells/mm³. Results: The average age of patients was 28.5 years (21-39 years). The women/men ratio was 1.7: 1 (36% men, 64% women). The average preoperative SE was -12.39 D (-8.00 to -23.00). In 69.74% (203 patients) we implant pIOL in both eyes. 189 eyes (69.74%) and 82 eyes (30.26%) had Artisan and Artiflex implanted respectively. The incidence of RD after pIOL implantation was 1.1% (3/271 eyes) of them was after artisan lens implant. Conclusion: The pIOL implant is a safe and effective option of correction high myopia. The incidence of RD was not different from the natural history of RD in myopic patients or high myopic patients with anterior segment surgery. Likewise, the prompt surgical management of this complication led to a satisfactory visual resolution in these patients. Resumen Propósito: Describir la incidencia del desprendimiento de retina (DR) en pacientes altos miopes evaluados a un año de seguimiento posterior al implante del lente intraocular fáquico (pIOL) Artisan/Artiflex. Lugar: Instituto de Ojos Oftalmosalud, Lima, Perú. Métodos: Estudio retrospectivo en el que se incluyeron 203 historias clínicas (271 ojos) de pacientes con alta miopía a los que se les implanto pIOL entre enero de 2004 a 2009, por un solo cirujano experto, con un año de seguimiento post operatorio. Los criterios de inclusión fueron pacientes mayores de 18 años, con equivalente esférico (EE) superior a -6.00 dioptrías (D) o longitud axial mayor de 26 mm, con una refracción estable de 2 años previos, agudeza visual mejor corregida (AVCC) mejor de 20/100, sin anormalidades en el segmento anterior y con un contaje de células endoteliales mínimo de 2,000 cel/mm³. Resultados: La media de edad de los pacientes fue de 28.5 años (21 – 39 años). La relación mujer/hombre fue de 1.7:1 (36% hombres, 64% mujeres). La media de Equivalente esférico preoperatorio fue de -12.39 D (-8.00 a -23.00). En el 74.90% (203 pacientes) fue implantado pIOL en ambos ojos. A 189 ojos (69.74%) y 82 ojos (30.26%) les fue implantado el pIOL Artisan y Artiflex respectivamente. La incidencia de DR posterior a la implantación de pIOL fue 1.1% (3/271 ojos). Todos ellos presentados en pacientes a los que se les implantó el pIOL Artisan. (3 ojos). Conclusión: El implante de pIOL es una opción segura y efectiva para la corrección de alta miopía. La incidencia de DR no fue diferente frente a la historia natural del DR en pacientes miopes o en cirugías del segmento anterior. No obstante, el manejo precoz de dicha complicación lleva a una recuperación satisfactoria de su AV en estos pacientes.

Resumen El tratamiento efectivo del edema macular representa un desafío principalmente debido a la limitada accesibilidad de fármaco vítreo para establecer y mantener niveles terapéuticos a largo plazo. El implante intravítreo de dexametasona (implante DEX; Ozurdex^®) es actualmente el único sistema de aplicación de fármaco ocular biodegradable aprobado por la Administración de Alimentos y Medicamentos de EE.UU. que proporciona liberación del fármaco a una tasa estable por hasta 6 meses en el vítreo. Estudios clínicos recientes indican que el implante DEX emerge como una opción terapéutica efectiva y segura para el tratamiento de edema macular secundario a diversas enfermedades subyacentes. Abstract Effective treatment of macular edema is challenging primarily because of the limited vitreous drug accessibility to establish and maintain long-term therapeutic levels. Dexamethasone intravitreal implant (DEX implant; Ozurdex®) is currently the only biodegradable ocular drug delivery system approved by the US Food and Drug Administration that provides sustained drug release at a stable rate for up to 6 months in the vitreous. Recent clinical studies indicate that DEX implant is emerging as an effective and safe therapeutic option for treatment of macular edema secondary to a variety of underlying diseases.

Purpose: To present the current state-of-the-art information regarding the properties, indications, surgical techniques, and toxic effects of current and past applications of vital dyes in chromovitrectomy. Design: Critical analysis and surgical perspective of the literature, recent studies and personal contributions. Methods: Review, interpretation, and comments regarding the most relevant experimental as well as clinical studies including the authors' clinical and laboratory research. Results: The evolution of vitreoretinal surgical techniques has been worldwide reported. Chromovitrectomy plays an important hole in these innovations and is very useful to improve the surgical results. There is a consensus that application of vital dyes facilitates the delicate removal of intraocular membranes during vitreoretinal surgery. Controversy still remains around various issues, mainly potential toxicity and safety. The dyes currently used for different steps in chromovitrectomy are: triamcinolone acetonide for vitreous identification; indocyanine green, infracyanine green, and brilliant blue for internal limiting membrane identification and trypan blue for epiretinal membrane identification. The indocyanine green may be toxic for the retinal pigment epithelium if subretinal migration occurs during the surgical procedure. Efforts to avoid subretinal migration of dyes are very important during macular hole surgery. The physiological osmolarity around 270-320mOsm as well as ideal concentrations of the vital dyes during vitreoretinal surgery are important subjects. Conclusions: The state-of-the-art staining-assisted procedures should be performed using concentrations and volumes as low as possible. Triamcinolone acetonide is the ideal dye for vitreous; indocyanine green, infracyanine green and brilliant blue are the ideal dyes for internal limiting membrane; trypan blue is the ideal dye for epiretinal membrane identification.

Primary central nervous system lymphoma is a rare primary brain tumor, accounting for 1% to 3% of all central nervous system malignancies, which may affect the eye in up to a quarter of the cases. Failure to diagnose and treat the ocular component increases morbidity and mortality. Ninety-eight percent of the cases of intraocular lymphomas are non-Hodgkin's B-cell. They may affect both the vitreous and the retina, while secondary invasion from a nodal lymphoma usually affects the uvea. Both forms frequently masquerade as intraocular inflammation. Systemic chemotherapy, alone or in combination with radiotherapy has been used for the treatment of these malignancies. However, when ocular involvement is present, due to the limited penetration through the blood-retina barrier of most of these drugs, adjuvant therapies should be employed. Ocular radiation have been administered in the past, however, due the high rate of recurrences, as well as the commonly seen side effects prompted additional modalities of treatment such intravitreal methotrexate and rituximab. Resumen Los linfomas primarios del sistema nervioso central (SNC) son una causa poco común de tumores cerebrales, constituyendo sólo del 1 al 3% de todas las neoplasias del SNC, pudiendo afectar al ojo en un cuarto de los casos. La falla en el diagnóstico y el tratamiento del componente ocular incrementa la morbilidad y mortalidad de estos pacientes. En el 98% de los casos de linfoma intraocular se trata de un linfoma no Hodgkin de células B. Pueden afectar tanto el vítreo como la retina, mientras que una invasión secundaria a partir de un linfoma nodal puede afectar la úvea. Ambas formas pueden enmascararse como una inflamación intraocular. Quimioterapia sistémica, solo o en combinación con radioterapia ha sido el tratamiento de elección. Sin embargo, si existe un componente ocular, debido a la limitación en la penetración de estos medicamentos a través de la barrera hemato-retiniana, terapia co-adyuvante debe ser considerada. La radiación de los tejidos oculares ha sido empleada en el pasado, no obstante, debido a la alta tasa de recurrencias y a los frecuentes efectos secundarios se han estudiado otras opciones de tratamiento como la inyección intravítrea de metrotexate y rituximab. Palabras clave: Malignidad ocular, linfoma ocular, linfoma del sistema nervioso central, sarcoma de células reticulares, linfomas de células B no Hodgkin, síndromes de enmascaramiento, metrotexate, rituximab.