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.